A simple explanation of a complex system of health insurance in the United States: personal experiences of an immigrant

Health insurance in the US is a very painful subject. Especially for those who moved recently and is in the country without a green card. The author of the blog “Then you are not there — about life in USA” to “Yandex.Zen” sort through all the most important information on health insurance in the United States.

Простое объяснение сложной системы медстрахования в США: личный опыт иммигранта

Photo: Shutterstock

Hereinafter in the first person.

State health insurance exists, but it is only for elderly people or for the military or for low-income families. But the choice of clinics for the poor is not so rich as the areas in which they are located.

Ordinary people have to buy their own and family health insurance themselves.

Insurance you can also provide your employer, but then the monthly cost of insurance will be deducted from your paycheck.

In the US there are three types of medical insurance:

  1. Dental (dental insurance).
  2. Eye care (vision insurance).
  3. A General nature medical (health insurance).

The employer usually prepares from all three listed species. Insurance are made at several large companies in the American market: Aetna, UnitedHealth, MetLife. It is not necessary that all insurance was the same company.

For example, we have health insurance from Aetna, dental from MetLife, and the eye — from VSP.

Medical services in the United States is outrageously expensive, so without insurance you can easily drown in medical debt. Looking through the statistics on the causes of bankruptcy for Americans, it’s easy to understand what to cheer for in the USA is not worth it.

A simple example: reception without insurance from a physical therapist can cost up to $400. If you have something serious and urgent, for example, with a fracture, was in the emergency room and spent a couple hours with a few procedures may be billed up to $10,000.

For each employer the insurance companies develop individual plans. So that the conditions can vary greatly depending on the insurance and the employer.

If to describe in General terms, the monthly amount of insurance the employee is deducted from the salary. This amount depends on how many family members inscribed in the insurance.

There was an opportunity for the insurance not to pay, but then this plan will require greater deductible. That is, for example, the first $10,000 per year for medical expenses I pay out of pocket, all the rest will cover insurance. Such a plan is good because every month from your paycheck nothing is subtracted, and if no one is sick, no spending and it is not happening.

If it was something major, the insurance will cover everything except the first $10 000.

Each insurance company has a list of collaborating doctors and hospitals (network). The doctor’s contacts sought usually through the website of the insurance, then you him call, to make an appointment and negotiated the price of admission. Even if you have a large deductible for the insurance, the cost of the doctor’s in the network will be cheaper than a doctor out of network.

Every therapist has their own rules, but in General the majority of doctors for you to pay anything on the spot will not. You then put up the insurance, and then you are already dealing with it.

Most drugs in the U.S. is sold by prescription only, and can only give the doctor. All recipes are made on the personal letterhead of the physician which stated his name, position, license number, address of the clinic where he receives, and your insurance information.

This recipe give you at the pharmacy, then the pharmacist communicates with your insurance, determines who will pay for drugs and what is the ultimate cost. The recipe you can get your hands on in the clinic or ask you to immediately send you a the pharmacy. Sometimes insurance may Express disagreement with the written prescription and then the pharmacist himself is associated with the insurance and doctor, and they jointly decide what to replace prescribed medication. Everything is very individual and depends on your plan, and sometimes from the human factor.

The pharmacist will give you as much of the cure as the doctor prescribed, no more and no less. In addition, if the recipe allows, you can make a Refill prescription and get the same amount of drugs again without a visit to the doctor. This kind of prescription depends on the doctor.

So we have one doctor wrote a prescription with the medicines only for a month, without the ability to renew without a visit, and another doctor for two months. That at least saved us $250.

In some States, even home medical equipment can be sold strictly on prescription. In the state of new Jersey, for example, you can buy without a prescription nebulizer.

About the teeth. The majority of dental plans cover most of the costs (ours covers 80%), and we for him per month pay nothing.

Eye insurance also covers up to 80% of the cost, plus it usually has a free sight test once a year + free spectacle frames (manufacture lenses are usually covered up to 70%).



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