Question

What are the most critical issues facing the healthcare system in the United States today?

Side note for insights you can find at the websites of these major health organizations: American Medical Association (www.ama-assn.org), American Hospital Association (www.aha.org), American Nurses Association (www.ana.org), and the Association of American Medical Colleges (www.aamc.org).

Answer 1

Health insurance is notoriously expensive and complicated in the U.S. Unlike Canada, most of Europe, and many other countries where universal health care provides a basic level of coverage to all citizens, the U.S. has a mixture of private and two kinds of government-run programs. Basic coverage in California and Florida can cost $450 per month, while similar plans in New York can cost upwards of $600 per month.

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The public programs, known as Medicare and Medicaid, are specifically designed for the elderly, people with disabilities, and low-income families and individuals. Everyone else needs to obtain private plans, either through their employer or on their own. Without one, you will still get treated in an emergency, but you are responsible for all of your medical expenses—and the bills can be astronomical.

Even when you do have an insurance plan, you may still get surprise bills. Most insurance plans require you to make co-payments at every doctor, and co-insurance—the percentage you pay alongside your insurer— can come as a surprise to many foreigners who are not used to this system.

Here’s a guide to help you prepare for navigating the labyrinth of the American health insurance, and a few tips on what to do before your move to potentially save on medical costs.

How does insurance work in the US?

Private health insurance is either offered through your employer or school, or you have to buy it on your own. You can select a plan that suits you best from the ACA’s Health Insurance Marketplace. The ACA, which stands for the Affordable Care Act—it’s nicknamed “Obamacare”—provides subsidies to those who can’t afford high premiums of insurance plans. The size of the subsidy depends on the individual’s income. Some states like California, Colorado, New York, and Massachusetts run their own healthcare exchanges.

The world of health insurance also has its own language and an extended glossary. It helps to learn a few of the essential terms in order to understand the plan you’re buying:

Premium: The monthly cost of your plan.

Deductible: The amount you pay out of pocket before your insurance kicks in.

Co-Insurance: The percentage of costs you still need to pay after your insurance kicks in.

Co-pay: What you pay the doctor at every visit.

Cost of health insurance varies widely, and it depends on the types of benefits you choose. Usually plans with higher premiums cover more of your medical expenses. In 2018, premiums averaged $440 per month for individuals, and $1,168 per month for families.

How do I get covered

If you are employed by a U.S. company, you are likely covered through an insurance plan offered by your employer. Some employers pay for the plan in full, while others may pay part of the fee and require you to pay the remaining cost.

If you have a work visa but plan to be self-employed, you will need to purchase health coverage yourself. You can find a plan in the ACA’s Health Insurance Marketplace during the enrollment time, typically running from November to December for the following year. If you arrive to the US outside of the enrollment period, you may still qualify to apply because of your special circumstances.

Ife a student or exchange visitor (F-1 and J-1 visas):

For international students on F-1 visas, most schools require proof of health insurance prior to enrollment, and typically automatically enroll students into their own student health insurance plan upon registration at the start of the semester.

The U.S. requires all exchange visitors (J-1 visa holders) and their accompanying spouses and children to have medical insurance. You can obtain an insurance plan through your university.