Medical insurance in the USA: the main features and variations
American healthcare is one of the largest industries in the country. In the United States, medical insurance is voluntary and is almost entirely provided by employers. Health insurance is the most common workplace insurance. But, employers are not required to provide it. Not all American employees receive this type of insurance. Yet, in the largest companies, medical insurance is almost essential.
How does it work?
Medical insurance in the US is selected based on several criteria. First of all, it is needed to determine the category the customer is related to:
- the poor people. In this case, the insurance will be paid at the government expense (Medicaid).
- people with low income and without insurance from the employer. Here, those who wish can personally arrange insurance, but it will be partially paid by the state.
- people with an average and higher income and without insurance from the employer. In this case, the insurance is arranged directly by the person based on his needs, the cost, etc.
- people with a particular income and insurance from the employer. In this situation, the person will have the insurance plan chosen by the employer.
- people over 65 y.o. or the disabled. They are entitled to Medicare subsidized by the government.
For children, there is a special insurance program (CHIP). Usually, it is either free of charge or has a very accessible price. In some states, it can also cover a pregnant woman’s expenditures.
Types of medical insurance in the US
Mainly, in the United States, there are private health care organizations. The share of the state ones comprises only 20%. There are two types of medical insurance options available in the US. The first one is a low-cost HMO (Health maintenance organizations). But, this option provides treatment only in certain healthcare organizations of a single network and only with one therapist. In turn, he decides on the need and possibility of visiting the patient with other specialists. Without medical insurance, an appointment with a specialist costs about $ 150. But, on average, even with a medical policy, you still have to pay from $ 50 to $ 100. Medical insurance in the USA does not cover 100% of a patient’s treatment.
In cases of emergency, an ambulance in other hospitals will still be provided to the victim with HMO insurance. The lower limit for the minimum coverage is approximately $ 160 per month. By the way, in the USA the fine for not having an insurance policy is about $ 100 per year.
The second option for health insurance in the United States is PPO (Preferred provider organizations). It will cost more expensive, but in this case, you can use the services on favorable terms in a certain health care network. Such medical insurance guarantees a free and independent visit to the right specialist. PPO implies special rates depending on the amount of compensation for services.
No one can predict for sure the state of their health. Therefore, the concepts of “ideal” or “most profitable” medical insurance are relative. Nevertheless, if you thoroughly understand all the nuances, there is a chance that you can choose the best option for yourself.
The main features that must be taken into account when choosing medical insurance in the US are:
- type of insurance;
- personal expenses;
- insurance network;
- the list of services and healthcare products.
One of the main principles of health insurance is the high efficiency of medical care. As for the costs of treatment, the insurance company usually covers the costs associated with the use of the only correct method of treatment.