Medical insurance in the US: What, Where and for how much to buy?

Being in the United States is not a cheap pleasure, so for all visitors and those who have not yet managed to understand the local order, we have prepared a short survey on health insurance. Is medical insurance in the United States mandatory, what types it is, how much it costs and where to buy it – read below!

What is medical insurance and who needs it?

Medical insurance in the United States is a contract with an insurance company, according to which you pay a certain amount to the insurance company every month, which, in turn, assumes part of the medical expenses in case of your illness.

Another significant argument in favor of running and concluding a contract is that according to the Affordable Care Act, medical insurance is compulsory for all legal residents of the country. For her absence, there is even a penalty (on average, $ 350-400).

For reference: US citizens, green card holders, refugees, persons granted political or humanitarian asylum, and nonimmigrant visa holders (including workers and student) are considered legal residents.

How to get medical insurance?

Based on the life circumstances of yours as well as income amount, you can:

  • Purchase by yourself;
  • Part of the costs incurred by the state
  • The state pays for insurance in full;

Insurance is fully or partially paid by the employer.

What are the types of health insurance?

HMO – health maintenance organizations. You will need to be treated in the institutions of one network, and you will have a primary general practitioner who will issue referrals to other specialists. Coverage does not include services provided outside the network, except in cases of emergency medical care.

PPO is the preferred provider of organizations. The network of institutions is still present, but it is much broader. You can be treated both in the network institutions and outside it (but the conditions in the network will be much more favorable). Also, you do not need to take a referral to specialists, they will take you on insurance without it. Buy medical insurance in the United States of this type will cost much more than all the others.

Point-of-service (POS) assumes that using the services of doctors and hospitals from the network, you will pay less. The Exclusive Provider Organization (EPO) is the same as the HMO, only without a primary doctor and mandatory referrals to specialists.

What are insurance plans and how much does it cost?

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

Platinum – about 90% 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%;

Minimal insurance – designed only for emergency cases and is available exclusively to persons under 30 years of age or to those who can confirm that they are in a difficult financial situation.

It is also worth remembering that insurance plans differ in a number of important points, like: co-pay (a fixed amount you pay for each medical service, and the balance is covered by the insurance company), deductible (the amount you need to spend before the insurance coverage), co-insurance (you pay a certain percentage of the cost, the rest is the insurance company), out-of-pocket maximum (the maximum amount spent during the year you start to receive 100 percent coverage from the insurance company).

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

The cost of insurance for the most part will depend on your income, the region and the selected insurance plan. For example, insurance type HMO from Kaiser Permanente in 2016 for a one-person family will cost from $ 160 (minimum insurance plan) to $ 315 (platinum plan) per month. To calculate the cost directly for you, use the special Shop and Compare Tool calculator on the official website.