ADMINISTRATIVE PROCEDURES
Healthcare costs in the USA are among the most expensive in the world. The smallest consultation can cost you a lot of money; as an example: $390 for a specialist’s examination in California; $34,000 for a natural, uncomplicated pregnancy in New York; or up to $60,000 for an appendicitis surgery in Florida.
The healthcare system in the United States is very complex, mainly because it is composed of many different programs and models, from which every individual must choose the one that suits him or her the best.
In this article, we will explain the American healthcare system in the simplest possible way.
WHAT IS THE AFFORDABLE CARE ACT (ACA)?
The Affordable Care Act (or ACA) is a law passed under the presidency of Barack Obama reforming the healthcare system in the United States. It is better known as Obamacare, but its formal name is the Patient Protection and Affordable Care Act. It has been in force since January 1, 2014 and remains partially in effect.
Its main target is to ensure that almost all American citizens have an adequate health coverage at an affordable price. It requires all citizens to purchase health insurance from a private insurer listed on HealthCare.gov as "ACA compliant", or otherwise face a fine, unless they are covered by Medicaid. In return, the state provides tax assistance to those who cannot afford the coverage.
As from January 1, 2019, U.S. residents no longer incur penalties if they do not have health insurance. Some states, such as Massachusetts, Washington D.C., New Jersey, or Vermont, have nonetheless maintained the health insurance requirement.
WHAT IS MEDICARE AND MEDICAID?
These two coverages were created by President Lyndon Johnson in 1965 to help the most needed people in the country.
MEDICARE is a program that benefits all Americans over the age of 65, as long as they have made contributions during their career.
On the other hand, MEDICAID is a program for people whose income is below or just above the poverty line. Each state can choose their own eligibility criteria: amount of refunds, household income, period of coverage, etc. Although this system allows the poorest people to be treated, the care received is basic and unfortunately more important treatments will not be considered.
WHAT HEALTHCARE INSURANCE TO CHOOSE?
If you work at a company with more than 50 employees for at least 30 hours per week, your employer must finance your health insurance. However, the insurance chosen may not meet your needs.
It may also be possible that you work in a company with less than 50 employees, or you are self-employed, or you want to complete your employer's insurance. In this case, it will be better for you, or even mandatory under penalties of fines (for the states of Massachusetts, New Jersey, Washington DC, California, and Vermont) to subscribe to a healthcare insurance.
There are 3 categories of healthcare insurance companies:
1) PPO (Preferred Providers Organizations)
They are healthcare insurance plans that cover all types of health care. However, care provided within their network of physicians and hospitals will be much better covered than care provided outside their network. Hence, the term "preferred provider".
2) HMO (Health Maintenance Organizations)
They are much more rigid in their practices than PPOs. On the one hand, they only pay for care provided within their network. Consultations and other health services provided outside their network are fully paid for by the insured.
On the other hand, they require the selection of a primary care provider (PCP), who must always be consulted before any visit to a specialist.
But they are more affordable than PPOs and they are the second most popular type of healthcare insurance for Americans.
3) II (Indemnity Insurances)
The "classic" healthcare insurances are often the most expensive solutions, the price of which depends on the level of coverage subscribed to.
Under these 3 categories there are 4 levels of refunds:
- - Bronze: This is the cheapest in terms of contributions, but also the one that offers the lowest rate of care coverage, with notably high deductibles. This type of coverage is totally inadequate for regular care.
- - Silver: Intermediate levels of contribution and coverage more expensive than the Bronze one, but lower than the Gold one.
- - Gold: It is the best compromise to be well refunded, but this solution remains expensive. Check that you require all the options.
- - Platinum: This is the most expensive of them, but it offers maximum coverage with no deductible in most contracts.
Please note: When choosing your contract, pay attention to the "copay" proposed, i.e., the remaining amount to be paid for each type of care. Most American healthcare insurance plans also provide for a "deductible", i.e., an amount that must be reached before being refunded.
HOW MUCH COSTS A HEALTHCARE INSURANCE?
As we have previously said, the cost for health insurance is very high. The amount we are going to give you is only an estimate and is susceptible to change according to different criteria such as:
- - The state you where you live in
- - The composition of your household
- - Your age and gender
- - And of course, your choice of health coverage
The average cost for one person is about $6,250 and $17,545 for a family of 4.
Are you an inmigrant in the United States? You can read this article.
Healthcare Insurance in America
Navigating the U.S. healthcare system and choosing the right insurance plan is a complex but crucial task. Whether you're considering PPO, HMO, or Indemnity insurances, understanding the nuances of each option and their coverage levels can guide you to make an informed decision. Tailoring your choice to fit your state, household, and personal needs is key to securing adequate coverage and managing healthcare expenses effectively.