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Medical insurance in the USA: basic information

Since 2014, medical insurance in the United States has been mandatory, and the medical sector itself is gradually being reformed with the light hand of Barack Obama, who promised people changes and tried hard to implement them.

Medicine in the USA is expensive. An ambulance call costs $ 50. Medical examination – from $ 30 in poor states. It’s easy to come and show where it hurts. Hospitals do not skimp on equipment, as in the CIS, so treatment is expensive. The best specialists cost more.

Medical expenses are the first reason for private bankruptcy in the United States. More than 60% of bankrupt citizens owe their deplorable situation to expensive ruthless medicine. Moreover, three-quarters of these bankrupts were insured. Therefore, insurance, even not the most profitable, is still often better than paying the bills yourself.

Insurance must be issued for all family members, including children. Most states have child insurance programs that are sponsored by the government and charitable foundations. For a child to receive this insurance, he must be a resident of the United States under the age of 18 and meet the conditions of the insurance company. Children’s insurance usually includes the services of speech therapists, ophthalmologists, and dentists.

HIPAA Compliance

HIPAA (Health Insurance Portability and Accountability Act) is a U.S. law that provides data privacy and security for the protection of medical information. The law has become more prominent in recent years with many health data breaches caused by cyberattacks and ransomware attacks on health insurers and providers.

HIPAA, also known as Public Law 104-191, has two main objectives: to provide continuous health insurance coverage for workers who lose or change their job, and ultimately to reduce health care costs by standardizing electronic transmission of administrative and financial transactions. Other objectives include combating abuse, fraud, and waste in health and health insurance and improving access to long-term care services and health insurance.

HIPAA compliance is regulated by the Department of Health and Human Services (HHS) and enforced by the Office for Civil Rights (OCR).

Medicare and Medicaid

There are also free insurance programs for the elderly and the poor. These are the famous Medicare and Medicaid. The first is all about age. The second can be obtained if your income is very low. Pregnant women, foster children under 26, and large families can count on help in paying for insurance.

How much does medical insurance cost in the USA?

The price of the policy and the amount of compensation depending on the terms of the contract that you conclude with the insurance company. In the office or on the website of the insurance organization, you will be offered several rates based on your age, income, and health status. If you do not have insurance, you will pay a fine if this fact is discovered. All US citizens and holders of any visa must have insurance.

There are several types of insurance plans:

  • Platinum, the insurance pays 90% of the costs, the monthly premiums are the highest.
  • Gold, the insurance company compensates for 80% of expenses.
  • Silver – 70%.
  • Bronze – 60%, it is the most popular, the fees are lower.

There is also minimal insurance. You don’t spend a lot of money, but only the most basic medical services are compensated for. This is a tariff plan for the young and healthy, the insurance will not work at the minimum rate with those who are often sick.

How does US health insurance work?

When seeking medical help, you spend the first money up to a certain amount yourself. This is called a deductible. After this amount is spent, the insurance company connects, which will compensate for part of your next expenses. The percentage that the insurance pays is called co-insurance.

Sometimes this is not a percentage, but a fixed amount for each service, this is called a co-payment. Each tariff plan has a maximum amount that you can spend on treatment yourself, after which the insurance pays for the rest. This is called the out-of-pocket limit. There is also an annual limit. This is the annual limit for the insurance, that is, the maximum amount per year that the insurance can pay for your treatment.

So, the logic: you pay the first money for hospital services until you spend the agreed amount. Then the insurance helps you pay up to the next agreed amount. After this amount, the insurance company takes all payments upon itself. And if there is no annual limit, then you continue to be treated at the expense of insurance, and if there is, if it is exceeded, pay again yourself.

How much does medical insurance cost in the USA and what does it cover?

The higher the monthly insurance premiums, the more favorable the conditions for you. The average cost of insurance for an adult per month is $ 250–350. A family of 4 spends a thousand dollars or more on insurance. These are tangible costs, and not all Americans can afford a full-fledged insurance policy.

Employers often offer insurance. The conditions differ, but on average you can count on a basic policy with the ability to buy insurance for your family members cheaper than directly from the insurance company.

Medical insurance usually covers the services of a therapist, examinations, and preventive procedures. Standard policies do not cover a specialty, such as an ophthalmologist or dentist. Cheaper insurance allows you to be treated only in a network of doctors cooperating with the insurance company. Then going to another doctor costs you more or is fully paid by you.

Minimum insurance covers emergency care, visits to a therapist, preventive procedures (check-ups and tests two to three times a year), and short hospital stays.

The most expensive insurance is for those who are sick a lot. For some diagnoses, for example, severe renal failure, the state assumes all insurance benefits.

The procedure for obtaining and validating medical insurance in the United States

In the United States, there is a purchase period for annual insurance: from November 15 to February 15.

If the family has moved, or in other extreme cases, insurance can be bought any day of the year.

Insurance is issued at the office of the insurance company or on the website. Most states have local insurance programs and rates. This site is nationwide. You can buy insurance from outside the United States.

When you get to the doctor, you are provided with services, and only after that, the case is sent to the insurance company, which decides that it can compensate. Sometimes, if a patient needs, but does not need, medical intervention, the insurance must be contacted in advance to inform them whether they will pay for your expenses or not.