Health insurance. How to make it right?
The system of health insurance in the USA is rather complicated. Sometimes it is even impossible to name the exact sums and coverages. Medical insurance is an agreement with the company. Due to this agreement, a person must pay a fixed sum. In return, the company helps solve all the problems and cover all the expenses on medical procedures. By buying medical insurance, a person protects himself from unexpected expenses in case of illnesses or injuries.
Is it necessary to get treated for free?
It is a popular mistake when people think that health insurance will cover all the expenses on treatment. In general, such type covers only a part of expenses. If a person has such insurance, it will help to avoid immense expenses.
Currently, every citizen of the USA must have medical insurance. This is a requirement by the ACA (Affordable Care Act). If a person doesn’t have such a cover, he must pay all the medical expenses himself. That’s not all. Except for this, the citizen must also pay a fine. The sum of the fine is $695 or 2,5% of the annual income.
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How to get health insurance?
Medical insurance can be got by several means:
- If you are poor, unemployed or a disabled person – the insurance will be paid by the State.
- If you have an income, but not so high, and the employer doesn’t pay for the insurance – you will have to buy it on your own, but part of the expenses will be paid by the State.
- If you are employed, the employer can pay it partially or totally.
- If you are working, and the employer doesn’t cover the health insurance, and the income is medium or higher – you must pay the sum on your own.
- If you are older than 65, you will get a subvention insurance Medicare.
Where to get it?
Earlier the insurance was sold by the insurance companies. Nowadays Affordable Care Act made companies sell health insurance through the market – Health Insurance MarketPlace. It is a big service, that helps to find a suitable offer, where insurance plans from different companies are got together.
Some states were against the offer to use the healthcare.gov website, and they worked out similar sites on their own.
Earlier everyone can buy the insurance when he wants. The companies can change prices when they find it necessary. Currently, Affordable Care Act made the companies keep the prices the same for the whole year. The health insurance can be bought from the 15th of November up to the 15th of February.
What are the types of health insurance?
There are several types of medical coverages in the USA:
- HMO. You can visit hospitals and specialists who have agreements with HMO. You must also choose a physician who will give you warrants to the specialists.
- PRO. In this case, the patient can apply to any hospital inside or outside the system. The doctor’s net in PRO is wider than the net in HMO or EPO.
- EPO. It is almost the same as HMO. The only difference is that you don’t need to choose the physician. You can visit a specialist onside the system without warrants.
There are also other types of health insurance offers. They are POS, PFFS, but the main types that cover almost 80% of the market are HMO and PPO.
The main problem with insurance in the USA is when you decide to visit a dentist or an ophthalmologist. It happened so, that the main part of insurance doesn’t cover these expenses. Nowadays more and more companies are trying to include these options in providing services. This might lead to the increasing of the insurance sum the client must pay to get it. At the same time, it will reduce the expenses later, when you decide to apply to the specialist.
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