Medical insurance in the USA

The health insurance system in the United States is complex enough for foreigners to learn. We have already written a general article on medicine in the United States,

In this article, we will look at the health insurance system in the United States: what is its cost, what are the ways to arrange it.

To begin with, it should be noted that the health care system in the United States is the most expensive in the world. For each resident of the country, the state expenses are approximately $ 15,000 per year, and the annual turnover of the amount to pay for medical programs costs the state $ 3 trillion. Despite this, a concept similar to the Russian OMS is not envisaged here. The state pays for health insurance only for low-income citizens, disabled people, the elderly and other needy people.

Medicare  is the US government health insurance program for people 65 and older. Also, this program is designed for residents under 65 years of age with disabilities or especially serious diseases, such as kidney failure. The program does not cover all medical care, but it helps pay for most medical services.

Medicaid  is a federal program that helps pay for health care services for low-income US citizens. This program provides benefits not normally included in Medicare, including home care services.
Child Health Insurance Program (CHIP) – This program provides assistance to families with children. The program targets uninsured children in low-income families where incomes are modest but higher than Medicaid requirements.

Key questions about US health insurance:

Are US residents required to have health insurance?

Yes, every American is required to have health insurance. Otherwise, all the costs of treatment will have to be paid for independently, and medical services in the United States are very expensive, although in some cases it may be more profitable to consult a doctor directly.  
Also, a person without insurance will have to pay a $ 1000 fine for evading compulsory insurance. Rarely sick people prefer to pay a fine, as it turns out to be more profitable for them than buying insurance.

How can you get health insurance?

Here are the main ways to get health insurance:

  • For needy segments of the population, the disabled and the unemployed, the insurance is fully or partially paid by the state.
  • If the family’s income is low and the employer does not pay for insurance, then you need to arrange it yourself. If the family falls under the requirements of the state health insurance program, then part of the insurance premiums will be compensated by the state.
  • When applying for a job, you need to find out if the employer will pay for your health insurance, in part or in full. This is a very common practice in the United States. Through the employer, you can take out profitable insurance not only for yourself, but also for your family.
  • Entrepreneurs and those for whom the employer does not pay for insurance are required to arrange it at their own expense.
  • Persons under 26 years of age can take out health insurance through their parents.

Dental health insurance and vision insurance are issued and paid separately.

Is the treatment provided free of charge with health insurance?

Unfortunately not. Medical insurance in the United States in most cases reimburses only part of work permit, however, given the cost of services in the United States, it will often be more profitable than paying for the treatment entirely out of your own pocket. The amount you have to pay yourself depends on the insurance plan and the service itself. For example, an annual examination by a general practitioner is 100% covered by insurance.

How does the insurance payment system work?

When contacting the clinic, you must present an insurance policy. Based on the format of your medical insurance, you will need to pay a certain amount for medical services.

What are the conditions for health insurance?

  • Deductible – independent medical expenses, prior to the commencement of insurance coverage;
  • Co-pay is a fixed amount that must paid independently for any medical service. The rest of the amount covered by the insurance company;
  • Co-insurance – a certain percentage is paid independently, the rest of the costs are borne by the insurance company;
  • Out-of-pocket maximum – a certain maximum cost per year, which is fully compensated by the insurance organization.

Where to get insurance?

The sale of insurance policies strictly controlled by the state. Therefore, at the moment, the only site for purchasing a medical policy for any insurance company is Here you can compare the formats and types of insurance and choose the most profitable option. Also, the law provides for the period for purchasing health insurance – from November 15 to February 15. But if a person’s social situation changed, for example, he got a different job / he has a wife / husband / children, then insurance is issued at any time of the year.

What types and plans of insurance are there?

There are two main types of health insurance policies:

  • Health maintenance organizations (HMO) is a budget insurance option that includes a specific network of medical clinics. This insurance policy does not apply to private practice doctors.
  • Preferred provider organizations (PPO) is a more expensive insurance option. With her, the choice of doctor and clinic is freer than with an HMO. If the insurance company has an agreement with the chosen clinic, then you will have to pay very little extra; if there is no contract, the amount of self-payment will be higher. But the choice of clinics for this type of insurance is much more than that of an HMO.

After choosing the type of insurance policy, you need to choose a plan that defines the independent payments and compensation of the insurance company.

Basic insurance plans:

  • Platinum – the insurance company pays 90% of the costs of medical services, respectively, the monthly premiums for this policy are quite high.
  • Gold – compensation from an insurance company – 80% of expenses.
  • Silver – 70% of the costs paid by the insurance company.
  • Bronze – compensation is 60%. This plan is in high demand as it is relatively inexpensive.
  • Minimal is the most budget-friendly plan that only compensates for basic medical services. It can only issued by persons under 30 years of age and those who for any reason have lost their current insurance.

How much does health insurance cost?

The cost of insurance is based on the type and tariff plan chosen. The average cost of a medical insurance policy for an adult is $ 250 – $ 400 per month. For a family, monthly premiums for insurance will range from $ 1000.

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