USA: about the medical insurance

Parent Category: ROOT Published: Thursday, 16 June 2022 Print
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Medical insurance in the USA

Medical insurance in the United States is a contract with an insurance company, according to which you pay a certain amount to the insurance company every month, which, in turn, takes on some of the medical expenses in case of your illness.

Medicine in America is very expensive, so insurance cannot be neglected. Another strong argument in favor of fleeing and making a contract is that according to the Affordable Care Act, health insurance is mandatory for all legal residents of the country. There is even a fine for her absence (on average, $ 350-400).

 

How do I get health insurance?

Depending on your life circumstances and income level, health insurance in the United States, you can:

  • purchase yourself;
  • part of the costs is borne by the state;
  • the state pays for the insurance in full;
  • the employer pays all or part of the insurance.

 

What types of health insurance are there?

HMO - health maintenance organizations. The cost of this type of health insurance in the USA is the lowest. And all because of the very limited number of doctors and hospitals that you can visit. You will need to be treated in one network and you will have a primary physician who will give referrals to other specialists. Coverage does not include out-of-network services except for emergency medical services. 

PPO - preferred provider organizations. The network of institutions is still present, but it is much broader. You can get treatment both in the institutions of the network and outside it (but the conditions on the network will be much more favorable). Also, you do not need to make a referral to specialists, they will accept you with insurance and without it. To buy this type of medical insurance in the United States will cost more than everyone else.

There are also other less popular types of insurance. Point-of-service (POS) assumes that you will pay less by using the services of doctors and hospitals from the network. An Exclusive Provider Organization (EPO) is the same as an HMO, only without a primary doctor and mandatory referrals.

 

Characters of a senior couple and health insurance illustration Free Vector

 

What insurance plans are there and how much does it cost?

Depending on the percentage of coverage for medical expenses, there are five basic insurance plans: 

  • platinum - about 90% paid by the insurance company;
  • gold - the insurance company pays about 80%;
  • silver - the insurance company pays about 70%;
  • bronze - the insurance company pays about 60%;
  • minimum insurance - designed only for emergencies and is available only to persons under 30 years of age or to those who can confirm that they are in a difficult financial situation.

 

It is also worth remembering that insurance plans differ in many important points, such as co-pay (a fixed amount that you pay for each medical service, and the remainder is covered by the insurance company), deductible (the amount that must be spent before the insurance coverage), co-insurance (you pay a certain percentage of the cost, the rest is the insurance company), out-of-pocket maximum (the maximum amount that you spend during the year you start to receive 100 percent coverage from the insurance company).

Dental and ophthalmic insurance is traditionally purchased separately. Dentist services only include medical insurance for children in the United States.

The cost of insurance will depend in large part on your income, region, and the chosen insurance plan. For example, HMO insurance from Kaiser Permanente in 2016 for a family of one person will cost from $ 160 (minimum insurance plan) to $ 315 (platinum plan) per month. To get a quote directly for you, use the Shop and Compare Tool on the Covered California website.

 

Where and when to buy insurance?

You can buy health insurance in the United States through the Health Insurance Marketplace. There is a nationwide resource, but some states have their sites. So, in California, you can buy insurance on the website.

The United States also has a specific time to buy insurance - from November 15 to February 15 of each year. But the prices for insurance during this very year remain unchanged. Of course, cases of moving, changes in the composition of the family, and the like are an exception and allow you to purchase insurance outside the specified period.

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