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health insurance in the US

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The United States of America is one of the five countries in the world where the cost of medical services is considered the most expensive. What can we say about visitors, if residents often do not receive emergency care due to the inability to pay for it? To get the minimum insurance for each family member, you need to pay $400-500 per month. Expensive insurance policies are not for everyone. There are many cases where medical care is not provided due to a lack of funds, but not all of them are illegal.

Content:

Types of health insurance in the United States.

How health insurance works in the United States

The cost of health insurance in the United States

What you need to know when buying an insurance policy in the US

About insurance for children under 18

Free insurance for pensioners and the poor

Why do I need health insurance when traveling to the United States?

Payment order for insurance issues

Types of health insurance in the US

There are many types of insurance in the United States. The largest insurance companies are:

cigarette;

Blue Shield Blue Cross;

UnitedHealthcare;

National anthem

There are not only types of insurance, but also plans for their financial support:

type of insurance – EPO, HMO, PPO;

plans – bronze, silver, gold, platinum.

According to the EPO, insured patients will not be able to receive treatment at all clinics, but only at the clinics specified in the contract. It does not cover patient referrals to private practice.

HMOs, limit the patient’s choice to one primary care physician (PCP, Provider, Primary Care). Only this specialist can refer the patient to another doctor. In this case, the insurance will cover the prescribed treatment.

PPO is the easiest option for choosing a doctor, but it also has its limitations. The service will be cheap if the doctor chosen by the patient has an agreement with this insurance company (on the network). If there is none (outside the network), the treatment will be much more expensive.

Insurance companies have many insurance options. Without special training, it is difficult to choose the right option. To do this, you need to have a certain set of concepts:

Premium – the number of monthly insurance payments;

D deductible – the number of advance payments for medical services until they are covered by insurance;

Co-payment – a fixed payment amount for medicines, medical services, or doctor visits;

Co-insurance – the percentage between the patient and the insurance company to cover costs (starts operating after the final deductible payment).

Out-of-pocket limit – funds spent from your own budget for the year, the payment of which you can rely on 100% coverage of their insurance;

Annual limit – the limit covered by medical expense insurance throughout the year.

How United States Health Insurance Works

If an insured person needed $100,000 surgery, their health insurance plan would look like this:

$ 2,000,000 – annual limit;

$3,000 – out-of-pocket limit;

20% – joint insurance;

$1,000 – deductible;

$1,000 is deductible.

This means that during the insurance year:

Patients donate $200 every month.

He paid himself the first thousand for medical services (minus $1000).

After payment (deductible), will begin to be paid (insurance): the percentage of the insurance company (80%) and the percentage of patients (20%).

This order will expire when the insured reaches an amount equal to the maximum spending limit provided for that year from his own budget (out-of-pocket limit) of $3,000.

Insured pays: $1,000 deductible + $2,000 co-insurance = $3,000 paid in full. This means that the insurance will now cover the remaining $97,000. It will continue to cover the insured’s needs until it reaches the (annual limit) of $2,000,000. For many plans, the annual cap has been removed since 01.01.2014.

Some plans implement payments on a co-pay basis, which means a fixed amount for medical care. If the patient pays $30 for a doctor’s appointment, the costs are covered using 2 options:

The company will pay an additional $170 if the cost of the visit is $200.

The Insured will pay $30 and will pay until the deduction is reached. He and the company cover a percentage until the out-of-pocket is reached, after which the company covers all bills in the amount of 100%.

Health insurance costs in the US

The cost of insurance contracts is different. They range from $150 to $500 per month. The final price consists of the following components:

income of one person (family);

type of insurance plan;

country;

medical history;

district;

age.

An American family (4 people) must pay up to $1,000 per month. Many families cannot afford this amount. In some cases, they are assisted by employers who partially or wholly sponsor health insurance for employees and their families, but at a higher cost. This option will be more profitable than buying it on the market. The terms of payment by the employer do not release them from their own budget until the completion of their deductible. Only after that, the company will start paying the percentage due for patient care.

Apa yang perlu Anda ketahui saat membeli polis asuransi di Amerika Serikat

The total number of insurance plans is divided into 3 groups:

High/Gold and Platinum are the highest of all existing premiums, conversely, the lowest out-of-pocket, as well as deductible. In this case, the co-insurance will be 80% to 20%. Such a plan is chosen by patients who have the opportunity to regularly visit specialists and receive treatment. They need a policy to avoid high prices. They can afford to pay large sums every month.

Medium/Silver is intended for most patients. This provides a higher premium, but lower out-of-pocket and deductibles. Co-insurance will be in the 80% to 20% range. The plan assumes that the monthly payments will be high, but the budget will remain when contacting specialists.

Catastrophic and Bronze assume that the amount per month (premium) will not be significant, but the deductible will be high and the percentage of co-insurance will be profitable. The plans are accepted by people who save on monthly insurance premiums. If you have to turn to specialists, large sums will be out of the budget before reaching the reduction. The plan is designed to protect against unexpected illness and protect against major expenses if they must be avoided.

It can only be purchased by people under the age of 29. The high monthly payment corresponds to the maximum amount and can be deducted from the low pocket, and vice versa.

When choosing an insurance plan, it is important to consider all the details of the coverage offered:

All insurance companies have 100% coverage for preventive checks by a specialist once a year.

All other expenses will be made after payment by the patient which is deductible.

Each company tries to offer specialist services from its network (in the network).

Switching to another specialist (outside the network) is fraught with reduced payments by insurance companies.

High/gold may offer compensation.

Medium/silver will provide a low percentage of cost compensation (co-insurance).

Disaster will not cover the cost at all.

Therefore, when choosing an insurance plan, you should pay attention to the wide network of medical institutions covered by the company.

About insurance for children under 18 years old

Features and differences exist in child insurance. Many states (Illinois) require insurance for children under the age of 18. All Kids (the insurance company) is committed to providing protection to all children in the state. This includes the following costs:

dentistry;

ophthalmology;

receiving drugs;

visit the pediatrician.

The All Kids insurance contract provides funds for the purchase of physical devices and speech therapy. To qualify for insurance, children must meet the following criteria:

Insurance requirements.

Children under 18 years of age.

Become a citizen.

Every child deserves it. To be eligible for All Children coverage, a family must meet the following requirements:

Number of people in the family Total income per year (or less)

5 $81,030

4 $69,150

3 $57,270

2 $45,390

The limit increases as the number of families increases. When employers pay insurance premiums for children, they are still eligible for insurance if they meet the requirements for it.

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Free insurance for retirees and the poor

For sick parents, there is free Medicare insurance. This category includes:

people aged 65 years and over;

people under the age of 65, but with certain diseases;

people diagnosed with end-stage renal failure.

People with limited incomes can get prescription drug coverage or help pay for Medicare. The rules for calculating income depend on the state of residence. Eligibility may depend on the following factors:

have US citizenship;

age;

disability;

pregnancy;

blindness.

The list of recipients of insurance in the Medicaid program includes:

individual Medicare recipients;

recipients of adoption benefits;

pregnant women and children under the age of six from families with incomes below 133% of the federal poverty line;

newborns to mothers with this insurance;

persons with disabilities, including the visually impaired, as well as those receiving benefits (Supplementary Security Income);

categories of people eligible for assistance under the AFDC program, as well as families with low-income minors.

Why do you need health insurance when traveling to the US

Russia’s healthcare system is different from America’s. Therefore, when planning a trip to the USA for any purpose, you need to consider these differences:

The United States does not provide health insurance.

Citizens buy insurance policies or pay for services from their own budgets.

Health insurance is not simple and confusing.

Insurance is different.

They have many conditions.

All citizens must have it.

The type of insurance can be any, but availability is required. It is impossible not to meet this requirement because at the end of the year you will have to pay taxes for his absence.

By law no. 155-FZ 28.12.15, travelers from Russia traveling abroad must take out a health insurance policy, the cost of which is 2 million rubles. Insurance will provide the necessary medical services free of charge:

receiving drugs;

doctor’s advice;

emergency delivery to medical facilities;

outpatient treatment;

analysis;

inpatient.

If the trip involves any type of risks such as playing sports or active recreation, then treatment in the event of an injury or fracture, for this reason, will be provided free of charge. When traveling to the United States on a tour package that includes this type of activity, it is better not to save on insurance. As for the other requirements for travel insurance, they are standard.

To get a visa to enter the United States, you need insurance. It is better to buy insurance in Russia. Insurance coverage must be for $50,000 – $100,000. Before concluding a contract, you need to clarify:

Is the insurance company accredited in the US?

Does he have an insurance program?

Assistant company.

Take into account the risks that will be required in the United States, especially in an emergency situation.

The purpose of the trip must also be indicated, as the cost of the insurance policy depends on this.

You can choose one of the programs that will save you from unexpected expenses in the event of a sudden illness or accident. Program choices depend on how often you have to travel to the United States:

When applying for a visa to visit friends or relatives (guests), you should choose an insurance program that carries the risk of “Community Liability Insurance”. If the insured person causes damage to the property, the insurance company compensates for the loss.

If the work or student visa is more than two months old, there must be an increase in insurance coverage.

For those who receive multiple visas, an insurance program is recommended for one year, during which the number of days of stay in the United States is fixed. Such an agreement is much cheaper than buying a separate policy for all trips.

If an insurance policy is purchased, the cost of medical services is covered by the insurance company. Insurance is protection against unforeseen circumstances associated with seeking medical care in the United States.

Insurance contracts need to be studied. A policy purchased for a visa with a minimum coverage of $50,000 takes into account the following risks:

Provide emergency outpatient services.

Transport of patients to health facilities.

Negotiations with aid companies.

Return based on medical indications.

Coverage of costs in terms of repatriation.

Insurance in the United States includes additional provisions for medical care in the event of an exacerbation of a chronic disease or allergic reaction.

The validity period of the policy starts on the day of departure abroad. The insurance contract is made in 2 languages ​​(English and Russian) in a printed version. If you decide to purchase insurance upon arrival in the United States, you must be prepared for the following risks:

Documents will be created in only one language (English).

The cost of an insurance policy issued by a US insurance company at the airport on arrival will be several times more expensive than in Russia.

Having insured himself against possible unforeseen risks, a person receives protection from financial burdens. At current US prices for medical services:

To call an ambulance – from $ 800 to $ 1,000.

One night hospital stay – $1,000.

Standard surgery costs to remove the appendix up to $60,000.

By comparing prices with odds, you can answer the question of why you need health insurance in the United States.

Order of payment for insured events

If the insured event occurs during a trip to the United States, you must follow the following algorithm of actions:

Within 24 hours, notify the insurance company of the incident at the telephone number specified in the insurance contract. Otherwise, the company will cancel the compensation or make a payment of 250 euros.

Translate all documents into Russian and certify by a notary.

Payment for insured events is made only based on documents requested by the company by the insurance company no earlier than two weeks later.

In the first case, insurance compensation is provided through the insurance company. Payment is made directly to the victim or service company in the presence of a doctor or after information about the insured event has been sent by telephone. Tourists will receive medical assistance within the scope of the sum insured or on a contract basis. The document-level proof is provided within 30 working days. You can not resort to the help of specialists without the knowledge of the insurance company, because the company will not pay for the insured event.

In the second case, the payment is made by the victim himself, notifying the Service Company of the occurrence of the insured event within not more than 24 hours. It is important to keep all checks that need to be presented upon arrival in the country of residence.

Health insurance in the US is required because there is no free healthcare in the US. Insurance contracts are required so as not to go bankrupt in treatment. By paying between $5,000 and $15,000 a year, you can get low-cost care. If you go to the hospital with a fracture without an insurance contract, you have to pay $11,000, and if you have insurance, it’s only $240, which is a significant difference.

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