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US Healthcare and Health Insurance

The US healthcare system can be quite confusing for expats and can even leave them with high bills to pay. In fact, getting proper health insurance before starting your assignment in the USA is essential unless you want to spend a fortune on hospital bills. Read our article for the full scoop!
The US healthcare system can be rather confusing for expats.

Until January 2014, US healthcare coverage has not been mandatory which is why many people, especially those with a lower income, have often been faced with high healthcare bills. Now that everyone is required to have health insurance, you can still decide what kind of US healthcare coverage you want to get. You can choose to purchase international health insurance or to get one of the different health insurance types available. In some cases, your employer will provide you with sufficient US healthcare coverage. In other cases, you will have to take care of this on your own.

US Health Insurance Explained

Although getting US healthcare sounds rather simple, it is not so easy to understand the different insurance types, exclusions, and special conditions various insurance companies offer. In addition, US healthcare is very costly, which is the reason why many Americans and also many immigrants have been without proper health insurance all this time.

Certain pre-existing conditions could lead to exclusion from US healthcare or to a very high monthly premium. While this is not the case anymore, it still makes sense to shop around and report every illness to your insurance provider. While it has been difficult for people with pre-existing conditions to find affordable US health insurance in the past, the new healthcare reform is making efforts to provide these people with health insurance in the future. The Affordable Care Act (also known as Obamacare), which was signed in 2010, should offer access to US healthcare from January 2014 onwards.

The Affordable Care Act

In March 2010, US politicians and the US government agreed and finalized a new health reform for the United States. Changes were not all made right away but rolled out over several years from 2010 to 2014. The timeline on the official government website shows which changes have been made when. They not only apply to American citizens but also to lawful residents and immigrants:

  • Tax credit for small businesses and middle-class families to help them afford health insurance
  • Pre-existing conditions insurance plan to cover the time until the Affordable Care Act takes full effect
  • Preventive care at little or no cost under new insurance plans
  • Continued coverage for young adults under 26 through their parents’ health insurance
  • Early Retiree Reinsurance Program
  • Filling the Medicare “donut hole” (The “donut hole” is a gap in the coverage of the Medicare drug plan)
  • Appealing Health Plan Decisions

The Affordable Care Act (often also referred to as Obamacare) is an effort to give more people in the USA access to healthcare, and to hold insurance companies accountable for their decisions. It also aims to protect patients from being denied coverage. It will make it harder for insurance companies to deny claims or coverage and to raise premiums.

International Health Insurance

Instead of getting a US healthcare plan, you can also buy international health insurance for the duration of your stay. International health insurance can be a great alternative, especially if you plan to stay in the United States for one year or less.

You should research international insurance companies very carefully before you sign up with them. While there does not seem to be a federal law which regulates the minimum health insurance coverage as of yet, insurance companies may have certain restrictions on which services and which medical service providers they cover. Also, doctors and hospitals do not accept every kind of health insurance.

Try to find out more about doctors, hospitals, and other medical service providers near your new home in the US. You should be sure that your international health insurance is the best choice for you and will cover the services of the US healthcare providers closest to you before you sign up with them.

When you are researching international health insurance policies, you should pay special attention to these aspects:

  • Duration of the time you are covered
  • Conditions, diseases, and services which are covered or excluded
  • Amount up to which you are covered
  • Can your insurance provider be reached 24/7
  • How are claims handled

You should also try to make sure that your international health insurance covers the USA and Canada. Because of high US healthcare costs, these areas are often excluded from international health insurance policies or have to be paid extra.

Medicaid and Medicare

The federal government provides people who cannot afford US healthcare coverage with insurance if they qualify for Medicaid or Medicare. You don’t have to be a US citizen to apply for these programs. If you are a lawful immigrant or resident and you contribute to the Social Security system, you are eligible to apply.

Medicaid provides low-income families and individuals with health insurance if they qualify for it and fit into the eligibility groups. In general, Medicaid covers basic health services and hospital visits. You may however be asked for a co-payment on some services. Your eligibility to receive Medicaid is based on different factors such as income, resources, age and your current health situation. Moreover, the specific requirements for Medicaid recipients vary from state to state. It is important for you to know that, even though you may not be able to receive Medicaid, your child may still qualify. Special rules apply for people in nursing homes and disabled children living at home.

Medicare provides health insurance to people over 65 or people under 65 with disabilities. There are different parts to the Medicare program:

  • Hospital Insurance (Part A) is covered through your payroll. It covers in-patient care in hospitals, short-term nursing facilities and hospice care.
  • Medical Insurance (Part B) is covered by a monthly premium. It covers general doctor’s services, outpatient care and some services of physical and occupational therapists when they are medically necessary.
  • Prescription Drug Coverage (Part C) is covered by a monthly premium and is designed to help make prescription drugs affordable and lower the costs. Private companies provide this insurance.

Generally any medical facility you attend needs to meet certain criteria to be covered by Medicare. They must meet the minimum standards and ensure a certain amount of safety and quality. If you already have Medicare, you are considered covered and do not need to get a new US healthcare plan under the Affordable Care Act.


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