Explaining Health Insurance in the USA

When people move to the United States as new settlers, one of the things they find very difficult to understand is the health insurance system. The reason for this is because the US health insurance system can be described as a unique type of health insurance. As much as some similarities can be traced between it and other types of health insurance systems out there, it still has some peculiarities that must be learnt before a new user can understand it well.

Health Insurance in the USAWhen you look at the physical aspect of what you see, you will realize that the quality of healthcare you will get in the US is almost the same thing with what you will get in some of the Western European nations, even though you may experience some old fashioned hospital buildings in some cases. One thing you have to bear in mind is that the private healthcare services that you can get in other nations do not exist here.

What you have here is insurance plans that are run by the government alone. The state and federal government run the entire insurance health plan in the US. In most cases, the plans in question are meant for specific set of people. This will include the unemployed, the less privileged, low income earners, underage people and the underemployed.

Because of the aforementioned, if you are planning removals to the US as an expat or as an immigrant, it is left for you to purchase a health insurance plan before you make the move or upon arrival. Most of the employers in USA provide these private health insurance for their expats or the expats can even purchase one for themselves.

If you are an expat from non-English speaking country, you also have provisions that will match your expectations. The US is known to be a nation of all nations and they also incorporate this in the health insurance plan.  The most developed and cosmopolitan areas in US, like Los Angeles, New York and Boston have plans and facilities that are run by staff who speak lots of foreign languages. If English is a problem for you, you can take respite in these.  People who speak, Spanish, Asian and some African languages can enjoy this.

If you want any services that relates to health insurance in the US, you will encounter a waiting time that is not more than the ordinary. This will depend on the time of the day, week or month you visit. If you are looking to get a new cover, you will be assigned a nurse who will run a test on things like diet, height, weight, allergies, illnesses and medications. This will provide the doctor the basis to carry out some tests and diagnosis. You must have a social security number to get this.

Health insurance plansThere are many types of health insurance cover in the US, and they cover different things. We have told you that while expats may get such from their employers, some may not get. For those who will get this, it may take them up to 3 months before their application is processed and they are given their insurance cards. For those who do not get it from their employers, they have to find a private insurance provider and buy the one they think is good for them.

However, even when you are enjoying an employment health insurance plan, you also need to contribute something in the name of the co-payment responsibility. This is paid every time you visit the doctor in the USA, though it may be very small. However, this may be increased if you are using a specialist like a dentist, or an optometrist.  A visit of $20 for normal health care will rise to $50 if a specialist is involved. All expats should have at least one plan on their name, if not; they will have to pay very exorbitant rates upon visits to hospitals. However, expats have no need of getting another plan if they already have one from their employer.

What should I consider if I am to choose a plan?

There are many things to be considered when choosing an insurance plan. These things are the things that will inform the plan you should choose both as an expat and as a citizen, and it is only when you must have considered and fulfilled this that you can now raise your head high and say that you have gotten the best health insurance cover.

You have to consider if you will be okay with the basic coverage or if it will be better for you to go for the comprehensive cover. Your health history, dependants, income and many other things should be looked into before you answer this question.

Health insurance costsYou also have to study the plan and inquire from the personnel if your doctor is covered in the insurance network.

If you already have a doctor and he is included in the network, you will be getting the insurance at a cheaper rate and you will get the highest amount of benefits too.

You also have to ask and know if the plan you are buying will cover you even when you have travelled outside the area you are living in or when you travel outside the country. If they have networks that spread farther than where you live, it will be better for you, though this may escalate the cost.

You also have to look to see if the plan you are choosing will cover all the services that are important to you. Things like preventive care, maternity coverage and many others are ad-ons. You should insure that these are involved in what you choose if you need them.

You also have to know if the plan works with a health savings account that will make payments and other transactions easier for you. You have to also ask if your plan will have the prescription drugs you take from time to time covered.  There are some guidelines and counselling that are due to some plans, you have to insure that such health counselling is involved in the plan you choose.

Plan Details

Accident Expense Plus $500

Health insurance Monthly Cost: $23.04

Details At a Glance

Plan Type:

Accident only injury reimbursement
Maximum Benefit Amount: $5,000
$1,000 - $15,000 per individual per year in $1,000 increments
Deductible: $500

Injury Benefits

Emergency Treatment: Initial care must be received within 72 hours of the accident (event causing the injury).
Accident Follow-Up Treatment: Follow-up Care is limited to three (3) visits and must be completed within 30 days of the accident (event causing the injury). Surgery is covered as a follow-up care treatment.

Hospitalization Benefits

Initial Hospitalization: Covered as part of Initial Care or Follow-up Care.
Hospital Confinement: Covered as part of Initial Care or Follow-up Care.
Intensive Care Confinement: Covered as part of Initial Care or Follow-up Care.

Recovery Benefits

Physical Therapy: PT can be on an inpatient or outpatient basis if prescribed by a physician and initiated within 30 days of the accident (event causing injury). Coverage for 10 treatments and must be completed within 6 months after the accident
Rehabilitation Unit: PT can be on an inpatient or outpatient basis if prescribed by a physician and initiated within 30 days of the accident (event causing injury). Coverage for 10 treatments and must be completed within 6 months after the accident

Transportation Benefits

Ambulance: We will pay for transportation by an ambulance to a hospital by a licensed ambulance company. Payable for transportation to a hospital from an accidental injury for a covered accidental injury.

Other Benefits

Major Diagnostic Exams: Actual charges, less any discounts or adjustments, up to the annual maximum per insured person, per year after the deductible is met.
Extra Services Discounts: Prosthesis Benefit. Will pay for one prosthetic device up to the annual maximum calendar year benefit if prescribed by a physician for dismemberment of hand, foot, arm, leg or site due to an accident. Available within one year from the date of accidental injury.

Additional Information

A.M. Best Rating: A as of 02/20/2014
Application Fee: No
Electronic Signature for Application Available: Yes
Will insurance company obtain and pay for medical records?

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