Choosing health insurance for the United States is not easy. Especially when you are an expatriate coming from a foreign country.
On the one hand, the stakes are high because healthcare is very expensive in the USA.
On the other hand, the American medical system is very different from other places. Here, you can find some useful information that will help you make the right choice!
Some Important Facts About Health Insurance in the United States
The American health care system relies almost entirely on private insurance companies.
Different Types of Health Insurance in the United States
There are 4 types of health insurance in the United States:
- PPOs (Preferred Provider Organizations): they offer the most flexible health coverage. All expenses are covered, but they are better reimbursed if the care is performed within the company’s network
- HMOs (Health Maintenance Organization): they only cover the costs of care received in their network of practitioners and health facilities. And they impose a system of Primary Care Provider who must be consulted before any visit to a specialist
- EPOs (Exclusive Provider Organizations): they only cover care received in their network, but do not require a referral physician
- POS (Point Of Service): they are similar to HMOs but cover certain care performed outside their network.
Vocabulary to Help You Understand the Health Insurance Plans in the United States
There are certain words you must know when looking at health insurance plans in the United States:
- The deductible is the amount that the insured must pay before the insurance company starts covering any costs
- The coinsurance is the part of the expenses that remains payable by the insured
- The out-of-pocket maximum is the maximum amount an insured can have to spend in a year; once this limit is reached, the insurance will pay the full amount of the medical expenses
- Coverages and exclusions are the risks covered or not by the insurance.
Is It Necessary to Take Out Private Health Insurance in the United States With a Local Company?
Most of the expatriates in the United States have three types of health insurance options:
- Choose a local insurance
- Remain affiliated to their country’s Social Security
- Take out an international policy.
Taking out a local policy for your health insurance in the United States is a common choice among American companies. They pay a part or the full amount of their employees’ policies.
This can be an interesting solution. But all the procedures will be done in the American way, which can be slightly different from how things are done in your country.
Also, the coverage will be regulated by the American insurance system laws and habits.
It’s recommendable that you are familiarized with all the facts about health insurance in the United States. And you should pay close attention to:
- Out-of-pocket expenses
- Imposition of a care network
- Limitation of the choice of practitioners.
This is not always the most comfortable solution when you are not familiar with the subtleties of the local health care system, its practices, and its particular vocabulary.
Local Policies Only Work in the USA
Expatriates who have the possibility of taking out local insurance must remember to verify that the contract covers all the members of their family.
He must also make sure that the proposed coverage corresponds to his specific needs as an expatriate living in the USA.
These policies generally offer a much lower level of coverage than what is offered in other countries.
And above all, this type of health insurance only works in the United States. It does not take into account the expatriate’s needs abroad.
For example, it will not be possible to benefit from certain important guarantees such as:
- Repatriation to your country in case of illness or accident requiring long-term hospitalization
- To be taken care of in case of early return in case of death or hospitalization of a relative in your country
- Be reimbursed for health care expenses during a temporary stay in your home country or a vacation outside the United States.
International Health Insurance in the United States
The Advantages of International Health Insurance Plans in the United States
International policies offer all the services listed in the previous section. This makes them the best health insurance in the United States for expats.
It’s even possible to add extended coverage according to his needs, such as:
- Personal effects insurance
- Insurance of identity papers in case of loss or theft
- Cancellation insurance for airline tickets
These contracts are offered by specialized companies that put their expertise at the service of the insured.
The communication with an advisor, as well as all the steps related to the subscription and the management of the contract are done in your language.
You generally have to choose between a 1st dollar insurance or a supplementary policy to your Social Security coverage. Each of them has its advantages and disadvantages.
Social Security Coverage
In some countries, Social Security offers coverage to expats when they go abroad. The main advantage is that there is no medical questionnaire upon enrollment.
People suffering from medical pre-existing conditions (chronic illness, serious pathologies…) can enroll without paying any additional fee or being excluded from coverage.
The main drawback is that its reimbursements are often too limited to cover the cost of care in the United States.
Some health care services are reimbursed according to the same scales and ceilings as those applied in your home country.
Other services are reimbursed at a fraction of the actual expenses. And it depends on the procedures performed.
In all cases, these reimbursements are much lower than the amounts invoiced, resulting in a high out-of-pocket expense for the insured.
This is why you should subscribe to a supplementary policy if you are planning to use your country’s Social Security as your insurance in the USA. And this increases the final costs.
First Dollar Policies: The Best Health Insurance in the United States
The best way to get cost-effective health coverage in the U.S. is to purchase a “first dollar” international health insurance policy.
These insurances cover health expenses from the first dollar spent by the insured, And at rates of real expenses known in advance, which avoids bad surprises.
Generally, the companies that market these contracts have concluded partnerships with American health networks.
This allows them to facilitate the procedures and reimbursements of their policyholders, and to optimize their coverage.
It is thus possible, for example, to benefit from a waiver of advance payment in case of hospitalization.
This private health insurance for the United States is very appreciated among the expatriates for its great flexibility.
The offers available are numerous and varied. And it is possible to add specific services according to one’s real needs. It’s like an à la carte coverage, or almost.
Finally, these contracts include repatriation insurance in case of accident or serious illness. And cover care provided during stays in your home country or other foreign countries.
It grants you that you will be taken care of efficiently at any time all over the world. But they still have a flaw:
- There is a compulsory medical questionnaire at the time of enrollment. And it can lead to an increase in the costs
- There can be exclusions of coverage or even a rejection of the application in case of declared pre-existing medical conditions.
Taking out Social Security insurance may be more advantageous if this is your case.
Since there are so many insurers out there, it can be complicated to make a choice, But it is possible to use an online comparator to find the best contract simply and quickly.
You will then be able to compare and find the most suitable health insurance for the United States.
Frequently Asked Questions
In the United States, there are 4 main categories of health insurance:
– PPO (Preferred Provider Organization)
– HMO (Health Maintenance Organization)
– EPO (Exclusive Provider Organization)
– POS (Point Of Service)
The concepts of health insurance to know in the United States are:
– The deductible
– The out-of-pocket maximum
– Coverages and exclusions
The cost of health care in the United States is much higher than in most of the world. For example, the price of a consultation with a general practitioner in the United States costs between 120 and 230 dollars.