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 go to the doctor's office and show your insurance card. At the reception desk, they take all the necessary information from it and return it to you, after which you go to the doctor. Based on the terms and conditions of your insurance, after the appointment you will be told if you have to pay anything extra. The terms and conditions are as follows:

• co-pay - this is a fixed amount that you have to pay for each medical service, with the insurance company covering the rest of the cost;
• deductible - this is the money you spend when you seek medical care before the insurance coverage kicks in;
• co-insurance - you pay the percentage agreed with the insurance company and the insurance company pays the rest;
• out-of-pocket maximum - this is the maximum amount you can spend within a year and receive 100% reimbursement from the insurance company.

At the end of the treatment, all documentation is sent to the insurance company, which pays the clinic for all expenses according to your policy. You will receive a statement (Explanation of Benefits) about how much the medical services cost you, how much the insurance company covered and how much you need to pay (if necessary).

Where to buy insurance?

Previously, you could buy insurance directly from insurance companies, but after Obamacare was passed, the government made them sell insurance through a special resource called healthcare.gov. On the site, all insurance plans are collected together, you can compare them and choose the right one.

You should also note that you can only buy insurance between November 15 and February 15.

What are the types and plans of insurance policies?

There are two main types of insurance policies:

1. Health maintenance organizations (HMO) - the most budget-friendly option, which allows you to be treated only in a specific network of medical clinics (of which there are not many). This insurance policy will not work if you go to private practice doctors. There is also Exclusive Provider Organization (EPO) - it is almost the same thing, but without an attending doctor and referrals to specialists.
2. Preferred provider organizations (PPO) - you choose on your own which doctor to go to for treatment. But, you should take into account that the chosen clinic must have a contract with your insurance (in-network), then the treatment will cost you a modest amount. If the contract is not concluded (out-of-network), then medical services will cost more. The list of clinics is much broader than with an HMO, and even if a clinic is not on the list, it will still be cheaper than with an HMO.

Once you have decided on the type of insurance policy, you need to choose a plan - it determines what your payments will be and how much compensation you will receive from your insurer.

Platinum - the insurer pays 90% of your expenses, but the monthly premiums for this policy are the highest.

Gold - 80% of expenses are reimbursed.

Silver- 70% of expenses are reimbursed.

Bronze - 60% reimbursement. By the way, this is one of the most popular types of insurance policies with a relatively reasonable cost.

Minimal - this plan is the most modest. It is suitable only for people under 30 years of age and those who have lost their current insurance for any reason. The plan covers only the most basic 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.

Are there any alternatives in Ukraine?

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. In Ukraine, the issue of insurance is not yet regulated at the state level, so payment for medical services often comes from the patient's own pocket. If in case of preventive appointments, it is quite adequate sums, then in case of complex health situations the cost of treatment can amount to hundreds of thousands of hryvnias.

AXA Insurance offers a unique solution to this problem - it is the "Medicine without Borders" program, specially designed for complex diseases. This insurance program compensates all major expenses for treatment abroad - from travel and accommodation to hospitalization and treatment.