How Does the US Health System Work?

Healthcare in the United States is organized is a complex bureaucracy. While in the rest of the world healthcare facilities are owned mostly by governments or by private sector businesses, in the US a large share of hospitals and clinics are owned by private non-profit organizations.

Yet, the United States is the country that has the highest healthcare expenditures in the world. While these expenditures are covered in a large share by public payers as by Federal institutions, or State and local governments, they can also be covered by private insurance and individual payments.

At the same time, unlike most developed nations, the US health system does not provide health care to its entire population. As there is no single nationwide system of health insurance, the United States primarily relies on employers who voluntarily provide health insurance coverage to their employees and dependents.

In addition, the government has programs that tend to cover healthcare expenses for the fragile parts of the society as the elderly, disabled and the poor. These programs differ from one another, and all have a specific kind of people that are subject to.

Getting health insurance in the US is not an easy thing. Someone may think that once you have money everything is easy peasy, but in fact things are a bit more complicated. One must be very careful and look out to pick the right insurance.

When looking up for a good health insurance plan make sure you ask questions like:

  • Does that plan grant you with the right to go to any doctor, hospital, clinic or pharmacy you choose?
  • Are specialists such as eye doctors and dentists covered?
  • Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
  • Does the plan cover home care or nursing home care and medications a physician might prescribe?
  • What are the deductibles? Are there any co-payments?
  • What is the most you will have to pay out of my own pocket to cover expenses?

Make sure you also understand how a dispute about a bill or service is it handled by your provider, as in some plans, you may be required to have a third-party decide how to settle the problem.

Health Insurance in the United States

The United States government does not provide health insurance for all its people, and health insurance is not obligatory for those living in the US. It is optional, but highly recommended and necessary, since health services are very costly, more than in any other country anywhere across the globe.

There are two types of health insurances in the US, private and public. Most people use a combination of both. The US public health insurances are: Medicare, Medicaid, and Children’s Health Insurance Program.

Medicare

Medicare is a national health insurance program that dates back to 1966. It provides health insurance for US nationals older than 65 years old, but also for younger people with end stage renal disease, ALS, and some other disabilities.

Data shows that in 2018, Medicare provided almost 60 million individuals with healthcare in the US, over 51 million of which were older than 65.

The Medicare program is divided into four parts:

  • Part A – which covers hospitals, skilled nursing and hospice services.
  • Part B – covers outpatient services, including some providers’ services while inpatient at a hospital, outpatient hospital charges
  • Part C – is an alternative called Managed Medicare, which permits patients to select health plans with at least the same service coverage as Part A and B, often the benefits of Part D, and an annual out of pocket spend limit which A and B lack. To sign in this part, one must sign in Part A and B fist.
  • Part D – covers mostly self-administered prescription drugs.

Medicaid

Medicaid is a federal and state program that helps people with limited income and resources to cover medical costs, while covering benefits normally not covered by Medicare, as nursing home care and personal care services.

It is the largest source of funding for medical and health-related services for people with low income in the United States. Data shows that the US provided health insurance to 71 million people with low income or disabilities, which is 23% of the total of US’ population.

Children’s Health Insurance Program

Formerly known as the State Children’s Health Insurance Program (SCHIP), this is a program that covers with health insurance children of families with modest income, that are not low enough to qualify for Medicaid.

The Affordable Care Act – Obamacare

The Patient Protection and Affordable Care Act is a federal statue signed into law by President Obama, which made it mandatory for every citizen to have health insurance or be penalized. The Act subsidies for low-income families, by taxing healthcare providers and high-income families, as it was designed to lower health care costs while providing better health care for Americans.

The Affordable Care Act allowed parents to ad their children up to the age of 26 to their policies, in a bid to have younger healthy people paying premiums. It also allowed poorer people to get treatment for chronic illnesses instead of using the emergency room.

US Private Health Insurance

There are about a thousand private health insurance providers in the US, with each of them offering different plans with different prices, which largely depend on a person’s medical history. However, while there are individual plans, covering only one person, there are also group plans targeting families in particular.

Usually, there are three types of health insurances in the United States:

  • Traditional fee-for-service health insurance plans which plans are usually the most expensive, that those with an income lower than the average income in the US, have difficulties to purchase. However, these are the best plans as they offer you most flexibility.
  • Health Maintenance Organizations (HMOs) which offers a limited choice of healthcare providers, yet it also offers lower co-payments and covers the costs of more preventative care. They are evaluated and accredited by the National Committee for Quality Assurance.
  • Preferred Provider Organizations (PPOs) which just like HMOs offer lower co-payments, but they give you more flexibility when selecting a provider, as they give you a list of providers among which you can choose.

Comparison marketplaces such as VisitorsCoverage offer a variety of Travel Health Insurance plans for visitors in the United States. To compare different plans and explore health insurance options you can visit their website here:

Trump’s Plans to Introduce Mandatory Health Insurance Requirement for Immigrants

A recent proclamation introduced by Trump in October intended to reject Immigration visas to the United States to immigrants who lack health-care coverage or the means to obtain health coverage once in the US.

According to the proclamation, US hospitals and other providers often administer care to the uninsured without any hope of receiving reimbursement from them, the costs of which are passed on to the American people in the form of higher taxes, higher premiums, and higher fees for medical services.

In total, uncompensated care costs — the overall measure of unreimbursed services that hospitals give their patients — have exceeded $35 billion in each of the last 10 years.  These costs amount to approximately $7 million on average for each hospital in the United States, and can drive hospitals into insolvency.  Beyond uncompensated care costs, the uninsured strain Federal and State government budgets through their reliance on publicly funded programs, which ultimately are financed by taxpayers,” the proclamation said.

As a result, US President Donald Trump wanted to stop allowing entry into the US to immigrants that do not have health insurance, with exceptions.

The proclamation outlined the accepted healthcare plans as follows:

  • Employer-sponsored plan, including a retiree plan, association health plan, and coverage provided by the COBR.
  • Unsubsidized health plan offered in the individual market within a State.
  • Short-term limited duration health policy effective for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States.
  • Catastrophic plan.
  • Family member’s plan.
  • Visitor health insurance plan that provides adequate coverage for medical care for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States.
  • Medical plan under the Medicare program.
  • Any other health plan that provides adequate coverage for medical care as determined by the Secretary of Health and Human Services or his designee.

However, a United States judge has blocked the proclamation asserting that it offered no national security or foreign relations justification for the sweeping change in immigration law.

Where to Find the Best Travel Health Insurance for Visitors to the United States?

One of the first things all tourists to the US have to prepare for when planning their trip is travel health insurance. Travel health insurance may not be mandatory, but it is highly advised, simply because of the high cost of health care in the US. The easiest way to buy travel health insurance for the US is online. You can buy travel health insurance online through comparison marketplaces such as VisitorsCoverage, which allow you to easily compare different plans from the convenience of your own home.

Why do we advise to purchase a health insurance plan through VisitorsCoverage?

  • With over 10 years of experience, they specialize in offering health insurance plans to international visitors in the United States from more than 175 countries.
  • You will get the lowest rates and all the necessary information that will help you choose the plan that suits you best.
  • You won’t be able to find cheaper prices anywhere else since the prices of travel insurance are regulated by the US government.
  • They offer dedicated customer service which is available to assist you seven days a week.
  • With over 1 million satisfied customers and a 97% customer satisfaction rate, VisitorsCoverage offers a wide array of health insurance plans tailored to your needs.
  • With VisitorsCoverage you can simply enter your destination, your age, and the duration of your trip, and get a quote, compare plans, buy your favorite policy and print it out. It’s that simple!

Things to Keep in Mind When Buying Travel Health Insurance

Before you purchase travel health insurance, you have to make sure that you are choosing the right plan for you. This means looking through different plans, carefully reading that they have to offer, compare the prices with the coverage, and making a decision. This being said, just as with most things, when it comes to the price of a travel health insurance plan, the more coverage it offers, the more expensive it will be.

The coverage: What type of travel health insurance plans are there?

Coverage-wise, there are two types of travel health insurance plans: comprehensive coverage plans and fixed-coverage plans.

 

Fixed coverage Comprehensive coverage
For this type of health insurance plan, there is a fixed amount that the insurance company pays for every medical procedure, regardless of the cost of the procedure.

So, let’s say there’s a fixed amount of $5,000, but you had to undergo a $50,000 surgery; in this case, you will have to pay approximately $45,000 yourself, depending on the deductible.

For this type of health insurance plan, the insurance company pays a percentage of the cost of medical procedures up to a certain amount. For any costs exceeding that amount, the company pays 100% of the costs up to the policy maximum.

(E.g: After the deductible*, the health insurance company will cover 80% – 90% of the first $5,000, then 100% of the expenses up to policy maximum).

You have to pay a deductible every time you get sick or injured. You have to pay a deductible only once for the entire policy.
They have a lower policy maximum**. They have a higher policy maximum.
They are usually cheaper to purchase. They are more expensive.

*The deductible is the amount of money you have to pay out of your own pocket for a medical procedure before the health insurance company begins covering you. For example, if you have a $2,000 deductible, you have to pay $2,000 first, then the company will begin paying.

**The policy maximum is the maximum amount that the travel health insurance policy will pay for any covered medical services or expenses. The policy maximum changes from plan to plan, and the higher it is, the higher the cost of the plan.

The price

The price of a travel health insurance plan depends on three main factors:

  • The type and amount of coverage you want. As mentioned above, comprehensive coverage plans cost more than fixed coverage. Additionally, there are plans which cover more medical procedures and/or emergencies, some can start from the day you land in the US, while others also cover you while you are traveling – so, the more coverage you want, the travel insurance plan will naturally cost more.
  • The duration. The price of health insurance changes depending on the duration that you need coverage for. A one-week coverage period will be cheaper than if you were purchasing insurance for one month, for example.
  • Your age. The price of all travel health insurance plans increases along with your age. Senior citizens generally have to pay more for the same amount of coverage than a younger person would. Additionally, some companies do not offer coverage for people over the age of 70 at all. See the best travel insurance plans for senior citizens.

Remember:

Do not get the cheapest plan you can find! Since cheaper plans equal much less coverage, in case there’s a medical emergency, you will just end up paying a lot more from your own pocket later on.

The prices of travel health insurance are regulated in the US, so it’s not like you can find a plan for a cheaper price elsewhere.

Pre-existing conditions coverage

Most travel insurance companies do not offer coverage for pre-existing conditions. For example, if you have diabetes, they will not cover the price of your diabetes medication while you are abroad. That’s because travel insurance is supposed to cover you only for any emergencies or incidents that happen while traveling.

However, there are several travel health insurance plans that offer coverage for the acute onset of a pre-existing condition.

Pregnancy coverage

Travel health insurance plans will also not offer coverage for any conditions related to pregnancy – at least, not to what would be considered a “normal pregnancy”. So, if you give birth, go for a check-up, or get assistance for things such as morning sickness while you are in the US, you will have to cover the cost of your medical bill yourself.

There are, however, some plans which offer travel insurance with coverage for pregnancy complications, but even so, the coverage is limited.

Health Insurance Requirements for Foreign Visitors in the US

Though the United States Authorities have not made health insurance mandatory for short-term travelers to the country, as B-1/B-2 visa holders, it is highly recommended for every traveler to get insurance before their trip to the country.

The main reason why you should get insurance is that healthcare in the US is extremely expensive and even a check-up for a simple headache will cost you hundreds of dollars, while a broken limb will cost you thousands.

Health incidents are never foreseen, therefore it is best to be prepared for it and get insurance, so in case of need you save yourself money.

Health Insurance Options for Legal Immigrants

Immigrants that are lawfully present in the United States are eligible to get private health insurance in the US. In addition, lawful immigrants may also eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income, as follows:

  • Those with annual income 400% of the federal poverty level or below may be eligible for premium tax credits and other savings on Marketplace insurance.
  • Whereas those with annual household income is below 100% federal poverty level that are not otherwise eligible for Medicaid are eligible for premium tax credits and other savings on Marketplace insurance, given that they meet all other eligibility requirements.

Most of the time, “qualified non-citizens” are eligible for coverage through Medicaid and Children’s Health Insurance Program (CHIP), given that they meet the income and residency rules of the state where they are based.

Qualified non-citizens” are considered the following:

  • Lawful permanent residents
  • Asylees, refugees, battered non-citizens & spouses, children, or parents, victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa
  • Cuban/Haitian entrants,
  • Those paroled into the US for at least one year
  • Conditional entrant granted before 1980
  • those granted withholding of deportation and members of a federally recognized Indian Tribe or American Indian born in Canada.

However, most of them will need to wait for 5 years in the US in order to get Medicaid and CHIP coverage in the US, after they get the qualified. Refugees and asylees are exempt from waiting period.

In addition, states have the option to abolish the 5-year waiting period for children and pregnant women so they can be covered by Medicare and CHIP.

Health Insurance Options for Illegal Immigrants

Illegal Immigrants in the US can get health coverage only from private providers, as the US government funded health insurance does not cover them.

Community centers can provide medical help to undocumented immigrants in the US, which is termed Safety Net Providers, if the healthcare seeker can participate in fee for service medical assistance.

Comparison marketplaces such as VisitorsCoverage, offer affordable health insurance coverage plans for visitors in the United States. 

At VisitorsCoverage website you find the best plan that meets your needs and compare different health insurance plans.

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