USA – Health Insurance Basics Everyone Should Know
Health insurance in the United States is mostly bought privately. Although the United States is the country where the greatest medical advancements takes place, it is also true that it is one of the few countries in the first world (perhaps the only one) in which there is no universal medical insurance. This means that this country does not guarantee or has a free medical insurance for its citizens or tourists. Only people with very few economic resources, can opt for a government medical service such as Medicare or Medicaid.
Most individuals in USA buy private health insurance through their employment, although rarely even the employer does not offer health insurance. American students, on the other hand, take advantage of the private health insurance offered by their own university, as it is low cost (about $1,000 per year).
The implications of not having universal health insurance cause universities or other educational institutions to force foreign students to take out a private health insurance plan upon arrival in the United States.
That is why it is recommended, even for tourists to take out private health insurance before visiting USA. It is one of the formalities to be completed. After buying a health insurance, you will have to pay monthly contributions, the value of which depends on the health risks you wish to insure, in order to benefit from coverage in the event of illness.
You can also live in the United States without any health insurance. But it’s at your own risk! In the event of a serious or minor health problem, you will have to pay all medical expenses out of your own pocket. For example, a cure for a Pneumothorax usually costs about $50,000 and a night in a hospital $10,000. This makes it necessary to have medical insurance.
As for private health insurance, it is important to keep in mind that not everything is usually covered. Therefore, when buying a private health insurance, it is important to know the following terms and also ask the insurer before purchasing medical cover:
“Copay” or Copayment: A fixed percentage that the insured has to pay for a covered service. For example, the medical insurance may cover 80% of each doctor’s visit and insured must pay the remaining 20% of the visit cost.
Out of pocket money: Insurer has to bear complete cost of medical services not covered (exclusions) by the medical insurance.
Pre-existing condition: Refers to the insured’s medical conditions prior to taking out private insurance. Many insurances do not cover treatment of previous illnesses. In addition, some medical insurance companies/plans, cover pre-existing conditions after a certain grace period has passed from the date of purchase of policy.
Limitations and exclusions: Medical insurance would not cover the total cost of certain treatments or medications. Exclusions refer to medical services or drugs that are not covered by the insurance.
Dental insurance: Dental insurance is usually not covered by private medical insurance, so you would have to pay an extra amount to get it.
Deductible: Amount of money that the insured has to pay in advance with any treatment or medical emergency. In the case of attending the doctor, the insured pays a bill and then fills out a series of papers to claim the amount paid, the insurance will return to the insured the corresponding part of that bill.
Covered medical expenses: Medical expenses covered by the insurance.
In-network and Out of Network Provider: The medical centers (consultants and hospitals) that are within the network of providers associated with the insurance. Charges by in-network providers are less compared to out of network providers.
Coverage/Prescription plan benefits: Services or drugs covered by insurance.
Emergency services: Emergency services covered by almost all health insurance.
Complementary services: Complementary medical services that must be paid for separately, such as dental or eye care services.
Dependents: In private insurance, dependents (spouses or children) can be added to the insurance by paying a certain amount.
Health insurance is most important for everyone living or traveling in the United States. And buying a health insurance policy should be done only after detailed checks.