Healthcare is particularly expensive in the United States, arguably the most expensive compared to many countries in the world. According to statistics, it would represent more than 16% of the monthly expenses of an average American household, and would appear among the first causes of debt and insolvency in the United States.
This is why it is recommended, even to tourists coming with an ESTA authorization, to take out health insurance when they are in Uncle Sam's country. It is one of the formalities to be completed , because in the event of illness or hospitalization , the bill can very quickly be steep.
Are you planning to leave for the United States? Find out how health insurance works in the USA!
Obamacare
The American president launched his social protection program in 2010: Obamacare . An expensive health system, without any support!
It is important that you know that the American health care system is very different from that in France. If there is indeed a Social Security, its role is not to cover the medical expenses of Americans, but rather to pay their retirement allowances. In other words, there is no health insurance in the USA!
Government funding
Of course, the US government is helping, but this funding is granted under certain conditions and only concerns a minority of the general public:
- seniors (over 65) as well as disabled people who benefit from the " Medicare " program
- families with children in great financial difficulty who benefit from the " Medicaid " program.
- Apart from these categories of people, funding in the health sector is almost non-existent.
Private financing
If you want to be covered for your health expenses, like all residents of the country, you will need to purchase "private" health insurance. Operating like mutual health insurance, you will have to pay monthly contributions, the value of which depends on the health risks you wish to insure, in order to benefit from coverage in the event of illness.
This initiative is not compulsory, unlike the French Health Insurance, you can also live in the United States without any health insurance. But it is at your own risk! If you have a health problem, whether serious or not, you will have to pay all of the medical costs out of your own pocket.
Employer funding
If you are coming to the United States for an internship or a job, you can ask the company that hired you or your sponsor to make “medical insurance” part of your prerogatives. But of course, he does not have to accept, so before accepting a position in the United States, do not forget to take this particular criterion into account.
Possible health plans in the USA
As you will have understood, you have an interest in being medically insured in the United States. Note that you will have the choice between three health plans: PPO, HMO and II.
1. PPOs or Preferred Providers Organizations
PPOs are private insurance companies that provide employees with medical coverage through their company. In other words, the monthly contribution will be borne by the latter which will pay it into a tax-exempt “Health Savings Account”.
Operating like the “collective company mutual societies” very common in France, the PPOs cover the medical costs, consultation costs and hospital costs of their members. And this, on condition that they have been caused by health professionals and hospitals that they have previously defined and with whom they work in close collaboration.
2. HMOs or Health Maintenance Organizations
The HMOs or Organization for the Maintenance of Health are entities offering both insurance and medical care services. In other words, by subscribing to this insurance company, in return for a flat-rate contribution, you will be able to benefit from a full benefit of care in the event of illness.
You will then be able to seek treatment from the organization's health professionals, but also by other specialists paid on a fee-for-service basis. Being able to treat other 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, meaning that they do not depend on any company or organization. They are thus based on a fairly simple provident system: insured members will contribute according to the risks they wish to cover. The more they are important, the more the contribution will be consequent.
Which health insurance to choose?
PPO, HMO or II? To choose well, base yourself on your needs, the real risks you will run and of course, your budget. Do not hesitate to inquire at the consulate before your departure and to simulate your online membership on your arrival. Comparing the different benefits that you will receive and the costs that 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-up before your departure and make sure that all your vaccines are up to date. If for some reason you need to take long-term treatment, be sure to take all of your medications with you. This will prevent you from buying some in the United States when needed.
Also take note of French-speaking doctors who reside and work in the USA.
Remark
If your budget does not allow you to take out proper health insurance, there is a final alternative: enrolling in a University as a student. This status allows you to benefit from HMO-type medical coverage.
Note, however, that this coverage is not complete: care is only reimbursed up to 80% and hospital costs are capped. But also admit that in exchange for weekly lessons on the subject of your choice, such an offer cannot be refused!
Some definitions to help you find your way
To help you better understand the American healthcare system, here is some jargon often used in this area:
- Copay : equivalent of the "user fee" in France, it is the amount remaining due after taking over your insurance
- Maximum out of pocket : this is the maximum ceiling that you will have to pay
- Deductible : it is the deductible, that is to say 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.
Do not confuse the social security card and social coverage
Even if you must ask for it on your arrival, the American social security number (ESC015) has nothing to do with the possible assumption of your health costs. This number has an identification role.
Translated from france-esta dot fr
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