- What is medical insurance and who needs it?
- How to get medical insurance?
- What are the types of health insurance?
- What are the insurance plans and how much does it cost?
- Where and when can you buy insurance?
- Insurance of kids under 18 years of age
- Free Insurance for Retired and Poor Medicare / Medicaid
- How to survive without insurance in USA
To be ill in the USA is not a cheap pleasure, so we prepared a short review of medical insurance for all visitors and those who were not yet able to figure out the local order. Is medical insurance in the US mandatory, what types of 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, under which you pay a certain amount of the insurance company every month, and she, in turn, incurs a part of medical expenses in case of your illness.
Medicine in America is really very expensive, so you cannot neglect insurance. Another weighty argument in favor of fleeing and contracting, according to the Affordable Care Act, medical insurance is mandatory for all legal residents of the country. For her absence, even a fine is provided (on average, $ 350-400).
How to get medical insurance?
Depending on your life circumstances and income level, you can:
- purchase independently;
- part of the costs is borne by the state;
- the state pays fully for insurance;
- insurance is paid in full or in part by the employer.
What are the types of health insurance?
HMO – health maintenance organizations.
You can visit those medical institutions that have concluded an agreement with the HMO (this does not apply to emergency care). You can apply to specialists only in the direction of your therapist. Plus HMO – in low premiums.
PPO — preferred provider organizations.
Differs from HMO with higher fees, as well as the opportunity to apply to specialists without referral. Only those medical institutions that have concluded an agreement with the EPO will have to visit (this does not concern emergency care).
Plan with the highest cost of insurance, but also with the most extensive opportunities. You can be treated in any institution, any doctors. If the doctor has also concluded a contract with the RFB, then you will be offered more favorable conditions. PPO also does not require a referral to specialists. PPO has the widest network of doctors.
Exclusive Provider Organization (EPO
Puts the following condition: specialists can only go with the direction of the therapist, but this specialist can take and outside the network
What are the insurance plans and how much does it cost?
Depending on the amount of coverage for medical expenses, there are five basic insurance plans:
- platinum – about 90% pays the insurance company;
- gold – the insurance company pays about 80%;
- silver – the insurance company pays about 70%;
- bronze – the insurance company pays about 60%;
- minimum insurance – is calculated only for emergency cases and is available only to persons under 30 years of age or to those who can confirm that they are in a difficult financial situation.
To be good at choosing insurance, it is also desirable to understand several terms:
- premium – the monthly amount that must be paid for insurance;
- deductible – the amount you have to pay for medical services before your insurance begins to cover them;
- co-payment – a fixed amount of co-payment for a visit to a doctor, medical services or medicines;
- co-insurance – coverage of expenses by the insurance company and you in a percentage ratio, beginning after a full payment of “deductible”;
- out-of-pocket limit – is the maximum amount spent from your pocket during the year after which the insurance begins to cover your expenses in 100%.
Dental and ophthalmic insurance are traditionally bought separately. The services of a dentist include unless the child’s health insurance in the US.
The cost of insurance for the most part will depend on your salary, region and chosen insurance plan. For example, the insurance type HMO from Kaiser Permanente in 2016 for a family of one person will cost from $ 160 (minimum insurance plan) to $ 315 (platinum plan) per month. To calculate the price directly for you, use the special Shop and Compare Tool on the official website of Covered California.
Where and when can you buy insurance?
Buy medical insurance in the US can be through the Health Insurance MarketPlace. It’s such an insurance market. There is a nationwide resource, but in some states own websites operate. So, in California, you can buy insurance on the site.
In the US, there is also a certain time for buying insurance – from November 15 to February 15 of each year. But the prices for insurance during this year remain unchanged. Of course, the cases of moving, changing the family numbers and the like are an exception and allow you to purchase insurance outside the established period.
Insurance of kids under 18 years of age
Many states rely on insurance for kids under the age of 18, regardless of the income and immigration status of their parents. As for the state of Illinois, this program is called All Kids. Its main goal is to provide free or affordable insurance to all kids in the state.
This insurance covers the provision of the following services:
- visits to the pediatrician;
- prescriptions for medicines;
- ophthalmologist services, including eyeglasses;
In addition, All Kids also covers the necessary medical equipment, speech and physical therapy. All kids who meet the following three parameters can receive All Kids insurance:
- The child must be a resident of state Illinois.
- The child must be at least 18 years of age.
- The child must be suited to the requirements of insurance.
What are these requirements and to whom are they applicable? Any uninsured child can receive this insurance, regardless of the size of his parents’ income. However, there are certain requirements for those kids who already have insurance, or 12 months have not passed since the termination of their old insurance. In this case, to get All Kids, your family needs to be approached under the following insurance requirements, based on the number of people in the family and the total income:
- 2 people in the family – $ 45,390 and less per year
- 3 people in the family – $ 57,270 and less per year
- 4 people in the family – $ 69,150 and less per year
- 5 people in the family – $ 81,030 or less per year
The more a person in a family, the higher the limit. If your family has more than 5 people, then the limit will be higher than the specified $ 81,030 per year. If your kids are covered by an insurance plan sponsored by your employer, they can still get All Kids if you match the above parameters.
This means, for example, if the insurance from your work does not cover the services of the dentist, and you are eligible, then these services will be provided to your child through All Kids.
Free Insurance for Retired and Poor Medicare / Medicaid
Medicare is a medical insurance for the following population groups:
- People age 65 or older.
- People under the age of 65 with certain diseases.
- People at any age with End-Stage Renal Disease (ESRD) (an incurable kidney disease requiring dialysis or kidney transplantation).
If you have limited income and resources, you can get the right to help pay for Medicare health insurance and / or insurance coverage for prescription medicaments.
For more information visit site of Social Security America, call Social Security at 1-800-772-1213 or contact your state’s Medical Assistance (Medicaid) office. If you have questions about Medicare, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Users of the TTY line can call 1-877-486-2048.
Medicaid is a health insurance coverage available to certain individuals and their families with limited income and resources. The rules for calculating your income and resources (such as bank accounts or other assets that can be sold for money) depend on the state in which you reside.
The right to participate may also depend on your age, pregnancy, the presence of blindness or other disability, and the citizenship of the United States. Some legal immigrants may also have the right to participate.
If the birth and delivery of a woman is provided by the Medicaid program, her child will have insurance coverage for up to one year without the need for an application for participation.
The major recipients of Medicaid insurance are:
- low-income families with under-age kids who are subject to the AFDC program;
- beneficiaries (Supplemental Security Income), as well as people with disabilities, including the blind;
- newborn babies born to mothers who receive this insurance;
- kids under 6 years and pregnant women in families whose income does not exceed 133% of the federal level of the poverty line (in some states this threshold can be set higher, as well as the age of kids can reach 19 years);
- beneficiaries of adoption benefits;
- some recipients of Medicare insurance.
Ifyou have questions about the Medicaid program (to find out if you have the right to participate or enroll in the program), you can call the Medical Assistance, Medicaid office of your state for more information. Visit official site of US Medicare or call 1-800-MEDICARE (1-800-633-4227) to find out the phone number. Users of the TTY line can call 1-877-486-2048.
How to survive without insurance in USA
Some people prefer not to buy insurance, and pay a fine at the end of the year. At the same time to get medical help, if ill, it is difficult, but quite realistic.
Otherwise, the statistics would not say that every fifth citizen of the United States either lives without insurance (in America there are more than 45 million uninsured people) or has so primitive insurance (more than 20 million), that for a primary and simple visit to the doctor should pay extra from his pocket.
Tip № 1. You should always be interested in whether there is an opportunity to pay for a visit, analysis, an operation not for insurance, but in cash. So, in many clinics you can take a blood test by paying cash.
For example: “If you pay in cash, the blood test will cost $ 98, and for insurance – more than $ 400.”
Tip № 2. You need to know the addresses and phone numbers of the “walk-in” clinic (out-of-hospital clinics) that are in your city.
In total, there are about 11,000 “walk-in” clinics in America. Doctors there prescribe drugs and directions for tests – in general, they render the same services as a family doctor who accepts a patient with insurance. The significant difference is that you can get to the doctor only in the order of a living queuing. Sometimes you need to wait 15-20 minutes, and sometimes in the queue you can spend a few hours. And most importantly – doctors in such clinics work in shifts, that is there is no guarantee that you, having come a second time, will get to the same specialist.
At the same time, the prices for services are quite high. For example – the cost of services in the largest walk-in network, the MinuteClinic clinic: a visit with a bronchitis or a small burn will cost $ 79-99, an adult vaccination against hepatitis A or B – $ 140.
Find a list of “walk-in” clinics in your city on this site, by typing “walk-in clinics” in the search box. In addition to the address, find out the time of work (some work from Monday to Friday, others – seven days a week and around the clock) and working conditions with patients. In many hospitals, you do not pay for a second visit, if you once again see a doctor within 36 hours from your first visit.
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