How Does Health Insurance In US Work

The American healthcare system is structured in an intricate bureaucracy. The majority of hospitals and clinics in the US are owned by private non-profit organizations, in contrast to the rest of the world where healthcare facilities are primarily held by governments or by enterprises from the private sector. This article is on health insurance in US.

Nevertheless, healthcare spending is highest in the United States of America. While a substantial portion of these costs are covered by public payers like Federal institutions, State and municipal governments, or private insurance, they can also be covered by individual contributions and private insurance.

In contrast to most industrialized countries, the US health system does not offer healthcare to all of its citizens. The United States relies heavily on employers who voluntarily offer health insurance coverage to their employees and dependents because there is no one national health insurance system.

Additionally, the government runs programs that often pay for healthcare costs for the most vulnerable members of society, such as the elderly, the disabled, and the underprivileged. These programs vary from one another and each target a particular group of people.

In the US, obtaining health insurance is not simple. Although some people might believe that once you have money, everything is simple, in reality, things are a little more complicated. To choose the appropriate insurance, one must be extremely cautious and vigilant.

Health insurance In US for non-citizens

Health insurance in Us is not a requirement for residents of the United States, nor is it provided by the government for all citizens. Although it is optional, it is strongly advised because health services are more expensive than in any other nation in the world.

In the US, there are two varieties of health insurance: private and public. The majority of people combine the two. Medicare, Medicaid, and the Children’s Health Insurance Program are the three public health insurance programs in the US.

The cost of healthcare in the US is the highest in the world. It is therefore strongly advised to obtain proper health insurance coverage.

Read Also: A Guide to Insurance in Spain


A national health insurance program known as Medicare has been in existence since 1966. It offers health insurance to US citizens over 65 as well as to younger people under 65 who have ALS, end-stage renal illness, and other disabilities.

According to data, about 60 million Americans received healthcare through Medicare in 2018, over 51 million of whom were over 65.

The Medicare program is divided into four parts:

  • Part A – which covers hospitals, skilled nursing and hospice services.
  • Part B – covers outpatient services, including some providers’ services while inpatient at a hospital, outpatient hospital charges
  • Part C –There is a different option known as Managed Medicare, which enables consumers to choose health plans with at least the same service coverage as Parts A and B, frequently the benefits of Part D, and an annual out-of-pocket spending cap that A and B lack. Parts A and B must both be signed in order to sign this part.
  • Part D – covers mostly self-administered prescription drugs.


Medicaid is a joint federal-state program that assists those with low incomes and resources in paying for medical expenses while providing services like nursing home care and personal care that are typically not covered by Medicare.

For Americans with low incomes, it is the main source of funding for medical and health-related services. According to data, 71 million Americans with low incomes or disabilities—or 23% of the country’s overall population—had access to health insurance in the US.

Children’s Health Insurance Program

This program, formerly known as the State Children’s Health Insurance Program (SCHIP), provides health insurance to children from low-income households who do not meet Medicaid eligibility requirements.

The Affordable Care Act – Obamacare

President Obama signed the Patient Protection and Affordable Care Act into law, making it a requirement for all citizens to obtain health insurance or face penalties. In order to cut health care costs and improve healthcare for Americans, the Act subsidizes low-income families by taxing high-income families and healthcare providers.

The Affordable Care Act allows parents to add their children to their coverage up until the age of 26, in an effort to get younger, healthier people to pay rates. Additionally, it made it possible for those in poverty to receive care for ongoing illnesses as opposed to going to the emergency room.

Insurance Coverage in the US

In the US, there are about a thousand private health insurance companies, each of which offers a variety of plans at various pricing points that are mostly influenced by an individual’s medical background. There are, however, group plans that specifically target families in addition to individual policies that simply cover one person.

Usually, there are three types of health insurances in US:

  • Health insurance plans with a traditional fee-for-service structure Such plans are typically the most expensive, making it harder for people whose incomes are below the US average to acquire. However, because they give you the most flexibility, these are the ideal programs.
  • HMOs, which have a constrained selection of healthcare providers but also charge reduced co-payments and cover the expenses of additional preventative treatment. The National Committee for Quality Assurance assesses them and grants them accreditation.
  • Preferred Provider Organizations (PPOs), which are similar to HMOs in that they cut co-payments, provide you greater flexibility when choosing a provider because they provide you with a list of options.

How to Choose a Good US Health Insurance Plan?

When looking up for a good health insurance plan make sure you ask questions like:

  • Does that plan grant you with the right to go to any doctor, hospital, clinic or pharmacy you choose?
  • Are specialists such as eye doctors and dentists covered?
  • Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
  • Does the plan cover home care or nursing home care and medications a physician might prescribe?
  • What are the deductibles? Are there any co-payments?
  • What is the most you will have to pay out of my own pocket to cover expenses?

As some plans may need you to have a third party decide how to resolve the issue, be sure you are aware of how your provider will handle a disagreement regarding a bill or service. The GeoBlue Xplorer plan is what we advise foreigners visiting the US to purchase.

Requirements for Health Insurance for Foreign Visitors to the US

Although short-term visitors to the United States with B-1/B-2 visas are not required to carry health insurance, it is strongly advised that everyone travel with insurance before entering the country.

The main justification for getting insurance is the high cost of healthcare in the US; even a check-up for a minor headache will set you back hundreds of dollars, while a broken limb will set you back thousands.

Since health incidents are seldom anticipated, it is best to be prepared and obtain insurance so that you can save money if necessary.

Options for Health Insurance for Legal Immigrants

It is possible for immigrants to purchase private health insurance in the US if they are lawfully resident in the country. In addition, depending on your income, legal immigrants may also be eligible for cheaper monthly premiums and out-of-pocket expenses, as follows:

  • Those with annual incomes at or below 400% of the federal poverty line may be qualified for premium tax credits and other discounts on insurance available via the Marketplace.
  • Those who fulfill all other eligibility conditions but have yearly family incomes below the federal poverty level and are not otherwise eligible for Medicaid are qualified for premium tax credits and other discounts on Marketplace insurance.

As long as they adhere to the state’s residency and income requirements, “qualified non-citizens” are frequently eligible for coverage via Medicaid and the Children’s Health Insurance Program (CHIP).

The following individuals are regarded as “qualified non-citizens”:

  • Lawful permanent residents
  • Asylees, refugees, battered non-citizens & spouses, children, or parents, victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa
  • Cuban/Haitian entrants,
  • Those paroled into the US for at least one year
  • Conditional entrant granted before 1980
  • those granted withholding of deportation and members of a federally recognized Indian Tribe or American Indian born in Canada.

However, after becoming eligible, the majority of them will have to wait five years in the US before receiving Medicaid and CHIP coverage. Asylees and refugees are not subject to the waiting period.

The 5-year waiting time for children and expectant women to be eligible for Medicare and CHIP may also be eliminated by states.

Here, you may request a free quote for US health insurance.

Even if you are free to select the plan that best suits you, we advise the GeoBlue Xplorer.

Health Insurance Options for Illegal Immigrants

Since the US government-funded health insurance does not cover illegal immigrants, they can only receive healthcare from private providers.

If the patient is eligible for fee-for-service medical aid, community centers—also known as Safety Net Providers—can provide medical care to undocumented immigrants in the US.

By Admin

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