The complete guide to USA health insurance

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Summary

In the United States, health care is a real business, and getting treatment is often expensive, even very expensive.

USA health insurance is organized in a totally different way from the system in other countries, and its functioning is even quite complex.

We explain the main points here.

The organization of health insurance in USA

In the USA, health insurance is entirely managed by private companies. They can be grouped into the following main categories.

PPO (Preferred Provider Organization)

PPOs are health insurance companies that cover all health care. However, care provided within their network of practitioners and facilities will be much better covered than care provided outside this network.

Hence, the term “preferred provider.”

PPOs are therefore the most flexible option on the market, since an insured person can visit any health care provider and still receive even partial reimbursements.

They are the most widespread, generally have extensive health networks and are often offered by large companies to their employees.

But their premiums are generally higher than those of other types of insurance.

HMOs (Health Maintenance Organization)

HMOs are much more rigid in their operation. On the one hand, they only pay for care provided within their network. Consultations and other health services provided outside the network are completely at the insured’s expense.

Secondly, they require the designation of a primary care provider (PCP), who must always be consulted before visiting a specialist.

HMOs are the second most common type of USA health insurance. In general, the premiums are lower than those of the PPO, but, as we can see, the possibilities of being reimbursed for health expenses are subject to several conditions.

Other types of health insurance in USA

Some companies offer packages halfway between HMO and PPO. For example, EPOs (Exclusive Provider Organization) only cover care provided in their network (except for emergencies), but do not require a referring physician.

Premiums are generally lower than PPOs.

The different levels of health plans

All companies offer four levels of health plans: Bronze, Silver, Gold and Platinum.

The Bronze plan is the least expensive in terms of contributions, but also the one that offers the lowest rate of care, with notably high deductibles. This type of coverage is totally insufficient for regular care.

The Platinum plan, on the other hand, involves much higher contribution amounts, but also the maximum reimbursement rates.

The Silver and Gold plans are intermediate levels of cost and coverage.

Obamacare in a few words

Obamacare, whose real name is the Affordable Care Act (ACA), reformed the health insurance market in the United States by making it compulsory for all residents of the country to take out ACA-compliant health insurance, i.e. insurance that is approved and available on a Marketplace (health insurance market), in return for assistance for those who cannot pay for such coverage, under penalty of financial sanctions.

From 2019, this requirement is no longer in place and U.S. residents are free to choose the insurance that suits them, or not to have any, except in a few states that have maintained this obligation.

Obamacare also introduced new rules for health insurance companies in USA, which make agreements more comprehensible and protect policyholders against the risks of abuse by the private market (free access to certain types of care, obligation to accept all applications for enrolment without a premium surcharge, prohibition of cancellation due to excessive consumption by the insured, introduction of annual caps for 10 essential coverages, etc).

Expats in the USA: which health insurance should you purchase?

For expats living in the United States, there are two main options: either your employer in the USA offers you health insurance, or you have to find one on your own.

Is it a good idea to choose local health insurance?

If you have the possibility to benefit from healthcare coverage through your company, this solution can be interesting because the costs of your premiums will be reduced or even non-existent. However, we advise you to look carefully at the guarantees included.

In fact, health insurance companies in the USA can be quite complex, and coverage rates vary widely.

Make sure that all members of your family will be covered and that you will not have to pay too much for your regular care or for hospitalization.

Also, keep in mind that the insurance will only cover health care expenses in the United States.

You will never be covered during your stays in your home country or in other countries (for example in case of holidays in Mexico or Canada during your expatriation), nor in case of medical repatriation to your home country.

International insurance for expats, the most comfortable solution

For those who do not benefit from an effective health insurance plan through their company, international insurance plans are generally the most interesting.

Their principle is simple: they cover your health expenses from the first dollar spent.

Often, you will even benefit from preferential rates and an international third-party payment system for hospitalization or co-payment medicine, as these insurances rely on well-established health networks.

In addition, it is possible to choose from a wide range of guarantees and levels of coverage and thus have a contract adapted to your specific needs and budget.

You can choose a plan that only covers hospitalization, regular care and repatriation, or a much more comprehensive plan that includes dental, optical and maternity care.

International health insurance covers treatment in the USA, but also in the rest of the world, including during stays in your home country.

It allows you to benefit from more different coverages, depending on your personal situation, such as protection of personal belongings against loss or theft, or legal assistance.

The insurance plan also provides access to useful services, such as applications that allow you to easily manage your agreement and procedures, or to access English-speaking assistance at any time.

In any case, to make a simple and free choice between USA health insurance offers available on the market, we recommend you to use an online comparison tool, which will allow you to find the best deals with detailed quotes and coverages.

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