United States health insurance and healthcare system

 In the discussion of  medical services in the United States , it is necessary to talk about its costs. Hospital bills are one of the leading causes of bankruptcy in the United States. Therefore, whether you are a non-resident or a green card holder, knowing the health care system of the United States will help you stay out of trouble.

Commercial health insurance dominates the US health care system. In fact, the private sector operates most of the healthcare facilities in the United States. Government medical services are only available to citizens and permanent residents of a certain age, and even its coverage is limited.

In addition, medical services are very expensive. For this reason, occupational health insurance is common among many American citizens and immigrants. But being insured does not necessarily mean that your visits to the doctor will be free. In most cases, you will have to pay a percentage of the hospital expenses out of your own pocket. 

On the other hand , the  US healthcare system provides high-quality care to patients. Hospitals and specialists are ready to provide services to those who can afford these services.

Costs aside, in this overview of the US health care system, we will introduce you to the ways to find the right doctor in this country and the complexities of having a baby there.

?How does health care work in the United States

Both the public and private sectors operate in the health care system in the United States. However, the coverage provided by government health services is very limited and mostly goes to people who cannot afford other types of health care. For this reason, many immigrants who come to the United States are likely to have to seek private insurance.

Note that public health care is the subject of much debate in the United States and is constantly changing. If you want to immigrate to the United States, keep yourself informed about the latest changes.

US Health Care Terms

Monthly premium: A monthly fee you must pay for insurance, regardless of whether you have used the insurance service or not.

Deductible: The amount you have to pay before coverage for medical expenses begins.

Co-insurance: The percentage you have to pay for services other than what insurance covers. This is after the deductible and requires you to split the bill with the insurer (40% and 60%, 30% and 70%, etc., depending on your insurance plan).

Health Insurance Marketplace: A group of private sector insurers that offer insurance plans that meet basic government standards (Affordable Care Act). Although the laws are the same, each state has its own market where different companies operate.

Short-term insurance plan: does not meet government standards and does not belong to the market. These plans are usually inexpensive, but lack full coverage.

Is there free government healthcare in the US?

At first glance, yes. But the main difference between US healthcare and most developed countries is that it is not universal. Government medical services are only available to people of a certain age and income. Many immigrant workers do not qualify for free government health care in the United States.

Who and what does government health care cover in the United States?

The United States  has government-funded programs to help more than 50 percent of the population. These programs are Medicare and   Medicaid and the Children 's Health Insurance Program (CHIP).

Medicare

Medicare is a program run by the United States government and is divided into four parts:

Part A – covers the cost of inpatient care;

Part B – helps pay for services provided by doctors and outpatients;

Section C – offers Sections A and B in one package, with the option of adding some other benefits;

Part D – helps cover the cost of prescription drugs.

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 Most citizens and permanent residents over the age of 65 are covered by Medicare Part A. You are also eligible for this section if:

You have been eligible for disability benefits for 24 months;

have kidney failure;

Have Lou Gehrig's disease or ALS.

Medicare Part B usually has higher costs, regardless of whether you qualify for Part B or not. Part B is separately pre-purchased (or in addition to the Part A plan) if you are 65 or older and if

Be a legal noncitizen who has lived in the United States for at least five years;

Be a US citizen.

Medicare Parts A and B together make up Original Medicare. It is possible to purchase supplemental plans from private insurance companies (Medigap).

Part C of Medicare is called a Medicare Advantage Plan, which in addition to the coverage of parts A and B, includes other benefits (such as more days in the hospital, coverage of eye and dental care services, ...) This plan is usually run by a private company. or offered by a Medicare Advantage Organization.

If you want your prescription to be covered, you must pay a monthly premium for Medicare Part D.

When you're eligible for either Part of Medicare, it automatically covers your Part A and Part B services; However, since Part B carries additional costs, it is always possible to opt out. Note that states provide financial assistance for people who cannot afford Medicare supplemental costs.

Medicaid and the Children's Insurance Program

Medicaid is a government program that:

helps low-income people pay for medical expenses;

Provides additional benefits not covered by Medicare.

Each state has its own eligibility rules, which may include:

Age;

Income;

Disability or health condition

Immigration status.

Note that in most cases you are eligible for Medicaid after 5 years of residence in the United States.

The Children's Health Insurance Program has similar eligibility rules. This program covers the cost of medical services (both medical and dental) for people under 19 years old.

About half of the states in the United States can provide Medicaid and the Children's Health Insurance Program to immigrant children and pregnant women.

The cost of government health care in the United States

The table below shows the average cost of government health care plans if you do not have the necessary conditions to receive a free program.

The cost of the medical service plan

A deductible is a fee that you must pay before receiving a specific service. This usually means that you must pay the full cost of the service to cover the total deductible amount. In Part A, you have to pay the hospital deductible (about $1,400).

A co-insurance  is a percentage you have to pay on top of what the insurance covers. This is after the deductible is paid and the bill is split with your insurer (40% and 60%, 30% and 70%, etc., depending on your insurance plan). In Part A, you have to pay co-insurance for the days you spent in a health care center after a certain period.

?Why is health care so expensive in the United States

Due to the lack of government regulations on the cost of medical services, private insurance companies , various medical centers and pharmaceutical companies can raise the prices by themselves as much as they see fit. People also tend to get a lot of tests and opt for more expensive procedures, and medical staff in the United States are highly paid.

Advantages and disadvantages of the health care system in the United States and other facts

Advantages

Quality service

Various options

Low waiting time

Disadvantages

You have to pay for most of the processes

Medical services are expensive and therefore not accessible to everyone

The price of medicine is high

The facts of health care in the United States

Although government insurance coverage is not universal, most employers provide adequate health insurance for you and your family.

If you don't have insurance, using an ambulance can be very expensive (prices vary by location, anywhere from $400 to $1,200).

The leading causes of death in the United States are heart disease and cancer.

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