Healthcare is costly in the United States, arguably the most expensive compared to many countries globally. According to statistics, it would represent more than 16% of the monthly expenses of an average American household and was among the leading causes of debt and insolvency in the USA.
This is why it is recommended that tourists coming with an ESTA authorization take out health insurance during their visit to Uncle Sam’s country. It is part of the formalities to be completed because the bill can very quickly be salty in the event of illness or hospitalization.
Are you planning to leave for the United States? Find out how health insurance works in the USA!
The American president launched his social protection program in 2010: Obamacare. An expensive health system, without any support!
It is important for you to know that the American healthcare system is very different from that in France. If there is indeed a Social Security, its role is not to support the medical expenses of Americans, but rather to pay their retirement allowances. In other words, there is no health insurance in the USA!
Of course, the American government helps, but this funding is granted under certain conditions and concerns only a minority part of the general public:
– seniors (aged over 65) as well as people with disabilities who benefit from the “Medicare” program
– families with children in great financial difficulty benefit from the “Medicaid” program.
– Apart from these categories of people, financing in the field of health is almost non-existent.
If you want to be covered for your health expenses, like all country residents, you will need to take out “private” health insurance. Operating like mutual health insurance, you will have to pay monthly contributions, which depend on the health risks you wish to insure, to benefit from coverage in the event of illness.
This initiative is not mandatory; unlike the French Health Insurance, you can also live in the United States without any health insurance. But it is at your own risk! In the event of a health problem, severe or not, you will have to pay all medical costs out of your pocket.
If you come to the United States for an internship or a job, you can ask the company that hired you or your sponsor to include “medical insurance” in your prerogatives. But of course, he is not obliged to accept, so before buying a position on American territory, do not forget to consider this particular criterion.
Possible health plans in the USA
As you will have understood, it is in your interest to be medically insured in the United States. So note that you will have the choice between three health plans: PPOs, HMOs, and IIs.
1. PPOs or Preferred Providers Organizations
PPOs are private insurance companies that offer employees medical coverage through their companies. In other words, the monthly contribution will be created by the latter, who will pay it into a tax-exempt “Health Savings Account.”
Functioning like the “collective company mutuals,” which are very common in France, the PPOs cover their members’ medical costs, consultation costs, and hospitalization costs. And this is on the condition that they have been caused by the health professionals and the hospital establishments that they will have defined beforehand and with whom they work in close collaboration.
2. HMOs or Health Maintenance Organizations
HMOs or Health Maintenance Organizations offer both insurance and medical care services. In other words, by subscribing to this insurance company, you will be able to benefit from a full healthcare service in the event of illness in return for a flat-rate contribution.
You can then be treated by the organization’s health professionals and other specialists paid on a fee-for-service basis. Being able to treat additional patients apart from contributors, they must nevertheless appear on the list of professionals approved by the HMO.
3. II or Indemnity Insurances
Undoubtedly the most expensive, Indemnity Insurances are independent insurance companies; that is to say, they do not depend on any company or organization. They are thus based on a relatively simple provident system: insured members will contribute according to the risks they wish to cover. The more important they are, the more the contribution will be consequential.
Which health insurance to choose?
PPO, HMO, or II? To choose well, base yourself on your needs, the real risks you will incur, and your budget. Do not hesitate to inquire with the consulate before your departure and simulate your membership online upon arrival. Comparing the different benefits, you will receive and the costs you will have to pay will allow you to save some money.
In addition, to minimize the risk of illness in foreign countries, carry out a complete health check before your departure and ensure that all your vaccinations are up to date. If you need to undergo long-term treatment for some reason, do not hesitate to take all your medications with you, and this will save you from buying them in the United States when needed.
Also, take note of the French-speaking doctors who reside and work in the USA.
Here are a few definitions to help you find your way around
To help you better understand the American health care system, here are some jargons often used in this field:
– Copay: the equivalent of the “ticket moderator” in France; it is the sum remaining due after the assumption of your insurance
– Out of pocket maximum: this is the maximum ceiling you will have to pay
– Deductible: this is the deductible, i.e., the amount from which your insurance will have to reimburse
– Coverage & Exclusions: this is the list of risks covered and not covered by your insurance.