Pharmacist

Insurance Plans in the USA

What is health insurance and who needs it?

US health insurance is a contract with an insurance company under which you pay a certain amount each month to an insurance company. It, in turn, contributes to the part of the medical expenses in case of your disease.

Medicine in America is really very expensive, so you cannot neglect insurance. Another powerful argument in favor of signing an agreement is that, according to the Affordable Care Act, medical insurance is compulsory for all legal country residents. For its absence, a fine is imposed. The fine amount is equal, on average, to $350-400.

US citizens, holders of a green card, refugees, persons who have received political or humanitarian asylum, as well as holders of non-immigrant visas (including workers and students) are considered legal residents.Insurance Plans in America

How to get health insurance?

Depending on your life circumstances and income level, US health insurance, you can:

  • purchase on your own;
  • part of the expenses is paid by the state;
  • the state covers the insurance in full;
  • the employer covers insurance plan in part or in full.

What types of health insurance exist?

The first type of insurance is HMO – health maintenance organizations. The cost of this type of health insurance in the USA is the lowest. It happens because you are eligible to attend the very limited number of doctors and medical facilities. You will have to be treated in institutions of only one network. You will have a primary physician who will issue referrals to other specialists. Coverage does not include services provided outside the network, except in cases of emergency medical care.

The second one is PPO – preferred provider organizations. The broader range of medical institutions can be visited to get professional help. You can be treated both in the network institutions and outside it. Also, you do not need to make a referral to specialists, they will take you in any case. Buying this type of medical insurance in the USA will cost much more than any other plan.

There are also other, less popular types of insurance. Point-of-service (POS) assumes that you will pay less using the services of doctors and hospitals from the network.

Exclusive Provider Organization (EPO) is the same as HMO. This is different only on a primary doctor and mandatory referrals.

What are insurance plans and how much does it cost?

Depending on the percentage of coverage of medical expenses, there are five basic insurance plans:

  • platinum – about 90% is paid by the insurance company;
  • gold – the insurance company pays about 80%;
  • silver – the insurance company pays about 70%;
  • bronze – the insurance company pays about 60%;
  • minimum insurance. It is created only for emergency cases. It is available exclusively to persons under 30 years of age or to those who can confirm that they are in a difficult financial situation.

Insurance plans are distinguished by many important points, such as:

  • co-pay (a fixed amount that you pay for each medical service, and the balance is covered by the insurance company);
  • deductible (the amount that you need to spend before the insurance cover starts to work);
  • co-insurance (you pay a certain percent of the cost, the rest is covered by the insurance company);
  • out-of-pocket maximum (the maximum amount spent during the year that you begin to receive 100% coverage from the insurance company).

Dental and ophthalmic insurance are traditionally bought separately. Dentist services include perhaps children’s health insurance in the United States.

The cost of insurance, for the most part, will depend on your income, residence and the selected insurance plan. For example, in 2016 Kaiser Permanente type of HMO insurance for a family of one person will cost from $160 (minimum insurance plan) to $315 (platinum plan) per month.

Where and when to buy insurance?

You can buy US health insurance through the Health Insurance MarketPlace. This is an insurance market. There is a national resource, but some states have their own websites. For example, in California, you can buy insurance on the website.

There is also a certain time for purchasing insurance in the USA – from November 15 to February 15 annually. But insurance prices during this same year remain unchanged. Cases of relocation, changes in family composition and the like are an exception. It allows you to purchase insurance outside the prescribed period.