How To
Health insurance in the United States: understand everything about the American health insurance system
Here is a thorny subject for expatriates in the USA: that of health insurance. And what uncertainties at the moment about the future of the health insurance system : while the functioning of Obamacare had not yet been understood by everyone, the new majority decided to get rid of it… and can’t do it! What to know to be well insured in the United States?
Michel Pensec
Michel PENSEC: For French people, you should above all know that there is no universal healthcare system, neither for residents nor for tourists. Therefore, medical costs are either your responsibility or that of your insurance, but in all cases, you have to pay to have access to it. Being confronted with the American medical system has an interest: realizing that medicine has a cost; it’s never something free. Someone has to pay. Nevertheless, there are many abuses in the United States.
That is to say?
You can be billed from single to double for the same care. Not to mention all the options they try to sell you when you are hospitalized, ranging from surgical techniques to a range of sandwiches that will be charged at different prices.
And, to go back to basics, if you are not well insured or if you cannot afford to pay… you can be refused hospitalization in the USA.
Even if you are in mortal danger?
Generally not, but in this case you will have an ambulance and emergency bill which will certainly amount to several tens of thousands of dollars, and the first thing you will want to do is to leave the USA as quickly as possible. and never come back.
So how do you get good insurance in the United States?
You have to do like everyone else – or almost – subscribe to a health/disease insurance plan, and there are several types of them.
Which ones?
When you are an expatriate, you have two options: either take out American health insurance, like any other resident of the United States, or take out an international insurance policy. First, you should ask your employer if they have coverage for you and your family. Otherwise, the best thing is to contact a broker like me: expats prefer in the overwhelming majority of cases to have international insurance.
Let’s start with American insurance. What are they ?
If you take out an ACA-compliant insurance policy, it must offer 10 essential guarantees:
– outpatient services
– emergency services
– hospitalization
– childbirth and care of the newborn
– mental health
– medical prescriptions
– rehabilitation services
– laboratory analyzes
– prevention and management of chronic diseases
– pediatric services (including eye and hearing care)
For all of these guarantees, no reimbursement ceiling can be set.
Should we be wary of certain aspects?
Yes, that’s where it gets complicated. You should know that your insurer may increase premiums for no specific reason from one month to the next, which may happen in the months to come.
Before signing, you also need to look at the deductible, ie the amount you will have to pay in any case in the event of a medical consultation or hospitalization. Many Americans pay for their health insurance every month, but they pay for their consultations at the same price as if they were uninsured. They therefore pay “for nothing”, but it is a guarantee in the event of a more serious problem or hospitalization: in this case they would be insured. With some, you have an annual cap. For example, the deductible is $1000 per year. Up to this amount, you pay, and then they take over. This amount is called the “maximum out of pocket”.
Emergency Ambulance In the United States
In the end, how much does it cost to be insured in the United States?
On average, it takes $500 per month for a single person, or $1,500 for a family of four. But prices are constantly rising. To this, we must therefore add the “maximum out of pocket”, if you are unlucky enough to fall ill.
It’s expensive compared to French-speaking countries!
In theory, salaries are higher in the USA and allow you to be well insured. Nevertheless, because this is not the case for everyone, Barack Obama had launched the Affordable Care Act, which is still in force, and allows those who have less means to be insured. In this case, the government pays the difference.
So the other option is international insurance, like the ones you sell…
Yes, and it’s really more advantageous and that’s why expats prefer them. In addition, they correspond more to their conception of a health system: you pay and then you don’t ask questions (you don’t need to constantly negotiate or call a lawyer to avoid being ruined )! In addition, they offer possibilities of “free choice” of the doctor, of the hospital, and also of the most appropriate care, whereas American insurance policies can force you to attend such doctor and such hospital as you do not not necessarily appreciate.
But are these international insurance policies compatible with Obamacare?
No, they are not compatible due to the international scope of coverage.
Nevertheless, the 10 essential guarantees mentioned above are respected in most of these policies with or without reimbursement ceilings. In addition, the insurer asks for a medical questionnaire when subscribing. Pre-existing conditions are conditionally accepted.
Will the Affordable Care Act (Obamacare) be saved?
I would be surprised. Republicans may not have been able to agree on how to end Obamacare, but they have no choice. They are likely to let insurers raise premiums until the system explodes. The only way to save it would be to refinance it, by raising American taxes, and that… they won’t!
