Health insurance in countries of the world: USA

1964. Johnson Lyndon, the 36th President of the United States from the Democratic Party, who replaced the assassinated John F. Kennedy, assumes the presidency. Some of his first decisions as President of the United States are the Civil Rights Act, which ended racial segregation in the southern United States, and the establishment of public health insurance (Medicare) and a program of assistance to the needy (Medicaid). This was the beginning of compulsory health insurance.

The second time the issue was revisited was in 2010, when President Barack Obama approved the Affordable Care Act, better known as Obamacare, one of the most expensive laws in U.S. history at a cost of $940 billion, which radically changed the U.S. health care system.

Its main goal was to make health insurance affordable for most US residents and to insure all citizens who were still uninsured. There were over 32 million of them at the time. They were mostly middle class people for whom commercial insurance was too expensive, but their incomes did not allow them to use the Medicaid subsidy program for low-income citizens.

The program has both supporters and ardent opponents, but let's not delve into this issue, but move on to the practical side of the question.

Are Americans required to purchase insurance?

Yes, according to the Affordable Care Act, every American is required to have health insurance. If a U.S. resident does not have health insurance, he or she will have to pay his or her own medical expenses and pay a fine to the government for avoiding mandatory insurance.

You can book a hotel in the USA with a discount of up to -65% on the website.

How do I get health insurance?

There are several ways to get health insurance:

1. Poor people, people with disabilities, and the unemployed are covered by the government (Medicaid).
2. If you have a low income and your employer does not pay for it, you will have to buy it yourself, but the state will pay part of the premiums.
3. If you work, your employer may pay for some or all of your insurance. This is much more cost-effective than buying it yourself.
4. Business owners and those who are not covered by their employer must buy insurance at their own expense.
5. Young adults under age 26 can get insurance through their parents.
6. For those over 65, there is government-subsidized Medicare insurance.

Does health insurance in the U.S. allow me to get treatment for free?

No, health insurance in the US covers only part of the costs, but given the high cost of medical services, it is your safety net against excessive spending. As Americans themselves joke, buying insurance actually insures against going broke. For example, if you have insurance, calling an ambulance will cost you $240, but if you don't have insurance, you will have to pay an average of $5000.

How does it work?

You visit a doctor and present your insurance card. At the reception desk, all necessary information is recorded from it and the card is returned to you, after which you proceed to your appointment. Based on the terms of your policy, you are informed after the visit whether you need to make any additional payment. The possible conditions are as follows:

• co-pay — a fixed amount you pay for each medical service, while the remaining cost is covered by the insurance company;
• deductible — the amount you must spend on medical care before your insurance coverage begins to apply;
• co-insurance — an agreed percentage that you pay yourself, with the remainder covered by the insurance company;
• out-of-pocket maximum — the maximum amount you pay within a year, after which you receive 100% reimbursement from the insurance company.

Once the treatment is completed, all documentation is sent to the insurance company, which reimburses the clinic for expenses in accordance with your policy. You then receive an Explanation of Benefits (EOB) detailing the total cost of medical services, the amount covered by the insurance company, and any remaining balance you may need to pay (if applicable).

Where to Buy Insurance?

Previously, policies could be purchased directly from insurance companies. However, after the adoption of Obamacare, insurers were required to sell policies through the dedicated platform healthcare.gov. The website brings together all available insurance plans, allowing users to compare them and choose the most suitable option.

It is also important to note that insurance can only be purchased during the period from November 15 to February 15.

What Types and Plans of Insurance Are Available?

There are two main types of insurance policies:

1. Health Maintenance Organization (HMO) — the most budget-friendly option, allowing treatment only within a specific network of medical clinics (which is relatively limited). This policy does not cover visits to private practice physicians. There is also the Exclusive Provider Organization (EPO), which is similar but does not require a primary care physician or referrals to specialists.
2. Preferred Provider Organization (PPO) — you choose which doctor to see. However, the selected clinic must have a contract with your insurance company (in-network) for services to remain relatively affordable. If there is no contract (out-of-network), medical services will be more expensive. The list of clinics is much broader than under an HMO, and even out-of-network services are typically less restrictive than with an HMO plan.

After selecting the type of policy, you need to choose a plan — this determines your payment levels and the percentage of expenses covered by your insurer.

Platinum — the insurance company covers 90% of expenses, but monthly premiums are the highest.

Gold — 80% of expenses are covered.

Silver — 70% of expenses are covered.

Bronze — 60% of expenses are covered. Notably, this is one of the most popular options due to its relatively affordable cost.

Minimal — the most basic plan. It is available only to individuals under 30 or those who have lost their current insurance for specific reasons. It covers only essential medical services.

How much does health insurance cost?

The cost is based on what type of insurance and plan you choose. On average, the cost of insurance for an adult per month is $250-350.

Thus, families with children spend more than $1000 per month on insurance.

As we can see, insurance medicine in the USA is expensive and not easy. The issue of convenience of compulsory insurance for society is still controversial, so the current U.S. government keeps the course on reforms.