Healthcare in the USA

This is why it is essential to get acquainted with the specifics of the US healthcare system and health insurance before moving.

Public healthcare in the US

Unlike most European countries, the United States doesn't have a national healthcare system. What this means in practical terms is that most American residents need to take care of their health insurance needs on their own.

However, certain population groups have their health needs covered by the government via Medicare, Medicaid, and Children's Health Insurance Program.

Medicare is a national health insurance program primarily designed for people aged 65 or over. The Medicare program is comprised of several parts:

• part A (hospital insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services;
• part B (medical insurance): Covers outpatient services, including doctor visits, preventive care, and medically necessary services and supplies;
• part C (Medicare Advantage): Offers an alternative to original Medicare (part A and part B) and is provided by private insurance companies. It often includes coverage for prescription drugs (part D) and additional benefits like vision and dental care;
• part D (prescription drug coverage): Provides coverage for prescription medications. It's offered through private insurance plans approved by Medicare.

If you are a citizen or resident of the US over the age of 65, you will be covered under Medicare Part A. This plan also applies to those entitled to disability benefits (for 24 months) suffering from kidney failure or Lou Gehrig's disease (ALS). Medicare Part B typically requires additional costs and is purchased separately. It applies to people over 65 years of age who are US citizens or have lived in the country as lawful non-citizens for over five years. Medicare Part C comes with additional benefits (extra days in the hospital, dental coverage, etc.). Medicare Plan D is needed to cover prescription medication and comes at a monthly premium.

In most cases, once you qualify for Medicare, you will be automatically enrolled in parts A and B. Note, however, that part B involves additional payments, and you are free to opt out of it.

Medicaid provides health coverage for individuals with low income. Note that each state in the US defines its own Medicaid eligibility criteria. Typically, the things considered include age, state of health, income, immigration status, and more.

Children's Health Insurance Program covers health care costs for children under 19 years of age. In some states (close to half), the program also covers immigrant children and pregnant women.

Good to know:

The healthcare system in the US has undergone several significant changes under the

Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA). The act is often nicknamed “Obamacare” as it was passed under the presidency of Barack Obama.

The key points of the reform include:

• universal medical coverage: US citizens and residents are now obliged to purchase medical insurance individually or through an employer);
• online health insurance marketplaces offering exclusively ACA-compliant insurance plans;
• expansion of Medicaid to cover individuals with incomes of 138% of the US federal poverty line (FPL);
• guaranteed minimum essential health coverage.

Medicare, Medicaid, and Children's Health Insurance Program are federally funded but individually managed by each state, so make sure to check with your state of residence.

Post-Covid healthcare in the USA

In the wake of the COVID-19 pandemic, the healthcare landscape in the USA has undergone some significant changes. Telehealth services have become much more popular, allowing patients to receive medical consultations and mental health support remotely. Regulatory barriers have been eased to facilitate expanding telehealth services so that more consumers can access healthcare this way. Understandably, there's also an increased focus on public health infrastructure and preparedness, with investments in testing, vaccine distribution, and pandemic response capabilities. Similarly to numerous parts of the world, in the US, the pandemic has underscored the importance of healthcare access and highlighted areas for improvement, leading to ongoing discussions about reforms and measures to address gaps in coverage and improve equity.

Affordable Care Act for expats in the US

If you are employed by a company in the US that has over 50 employees and you work over 30 hours per week, your employer will provide you with health insurance. This is an official requirement for employers in the US, and failure to provide insurance will result in a penalty.

As an employee, you will be required to pay part of the insurance premium offered by the employer — depending on your household income.

If you decide to take out an individual insurance policy, the rules are a bit different.

In the past, all persons residing in the US (including expats) had to purchase an ACA-compliant health insurance policy. Otherwise, they would risk paying a fine.

Now, however, the federal government has revoked this mandate. This means that if you do not take out ACA-compliant health insurance, you will no longer need to pay a penalty.

Private health insurance in the USA

All private health insurance policies in the US operate off of a system of premiums (fees) and deductibles (the amount up to which the individual is required to pay). Based on your insurance package, you will pay a premium each month. When you have an operation or long-term treatment, your insurance company will begin to cover your care only after the deductible is met. The lower the deductible, the higher the monthly premium. Routine doctor visits and exams are covered by a flat fee. Prescription medications are also covered in health insurance packages, either by a co-pay or once your deductible is met.

Your employer can provide private health insurance in the US, or you may purchase coverage individually. Employer-offered health insurance can come in the form of a lower premium or a Health Savings Account, which allows you to deposit untaxed pay into a special account used solely for medical services. It is not required that US employers subsidize health coverage for employees. However, since healthcare insurance is expensive, it is a benefit that many employees seek when applying for a job.

International health insurance

You can also subscribe to international health insurance before moving. There are many insurance companies to choose from in the USA, according to your needs and budget.

Some of the leading health insurance providers are:

• Allianz Care
• Regency for expats

Consider looking at their offers according to your needs and get a free quote on Expat.com's Health Insurance for expatriates in the USA page.

Read also Health insurance in the US

Important:

You must familiarize yourself with your policy before you sign up for coverage. Ensure you understand what treatments your insurance will cover, how much they will cover, and what you will pay out of pocket.

Good to know:

A social security number (SSN) or Individual Tax Identification Number (ITIN) is used to track individuals for tax purposes and is a common ID in the United States. Permanent and temporary residents should request an SSN or ITIN when they are granted a non-visitor visa. To sign up for a private health insurance policy, you must provide one of these pieces of identification.

Hospitals in the USA

Most hospitals in the US are privately owned: they are either managed by non-profit organizations or boards of investors. Most US hospitals are very well-equipped and have some of the best technological facilities in the world.

Waiting times depend on the hospital and the treatments you require. Having private insurance can significantly shorten wait times for important procedures. Most importantly, having health insurance is the only way to manage medical care costs in the US. Without health insurance, you should be ready to pay very hefty sums for hospital visits. For instance:

• a general consultation with a doctor can cost from $100 to $200. However, without insurance, the cost of going to a doctor can range from $300 to $600, depending on whether you see a specialist, if lab tests are completed, and if any procedures are done;
• without insurance, the average cost of an ambulance ride is around $1,200. The average charge for an Advanced Life Support (ALS) ambulance ride is $1,277 and a Basic Life Support (BLS) ambulance ride is $940;
• the cost of additional tests can indeed range from $100 to over $1,000; depending on the type of test and location;
• the average per-day hospital cost in the US is $2,883; with California ($4,181) being the most expensive, and Mississippi ($1,305) being the least.

How to find a general practitioner in the US?

The first thing you should do when looking for a medical practitioner is consult your insurance company to see the list of doctors and hospitals available under your plan. Next, you can check local online databases for more information on different practitioners. It is also a good idea to check with friends and colleagues for recommendations. Once you have selected a practitioner, you can contact the hospital directly and schedule an appointment.

Your first visit to a general practitioner will generally involve questions about your medical history, current health condition, personal details, and more — so make sure that you have all the needed documentation with you.

If needed, you can schedule several appointments to make sure you find the doctor you feel the most comfortable with.

How to find a specialist practitioner?

Based on your insurance plan, you may need a referral from your general practitioner to book an appointment with a specialist. In any case, you can also use local medical databases to check available practitioners and see which doctor may be a good fit. Some of the most popular medical databases include American Medical Association and Medicare.gov.

Good to know:

Dental care is not included in most insurance plans. This means that you will be able to choose your dentist without consulting your insurance company. If your employer does provide health insurance with a dental plan, you are in luck — in this case, you will need to choose a dentist from the list provided by your healthcare insurance provider.

Here are examples of average dental costs in the US:

• the cost of a first dental visit can range from $50 to $400. This price often includes not just the exam but also dental X-rays and teeth cleaning;
• a standard teeth cleaning can range from $75 to $200, with an average cost of around $125. However, if it has been a while since your last visit to the dentist, they may recommend a more extensive deep clean, which can range between $500 to 4,000 depending on the amount of time and work that is needed;
• the cost of a dental X-ray can vary greatly, typically ranging from $25 to $750. The price varies by provider, what location you are getting the X-ray, the part of the body needing the X-ray, and how many views need to be taken;
• filling a cavity usually costs between $50 to $150 for a single silver amalgam filling, $90 to $250 for a single, tooth-coloured composite filling, and $250 to $4,500 for a single, cast-gold or porcelain filling.

Mental health in the US

For expats new to the USA,  understanding how mental health care works is important. Navigating the American mental health landscape requires understanding the complexities of your health insurance coverage, the different therapy options, and how to access emergency mental health care, should you require it.

Make sure you understand your health insurance plan and its coverage of mental health services, which encompass therapies, counselling, and prescription medications. Opting for in-network providers can significantly reduce costs, ensuring you receive quality care without incurring hefty expenses. There are some kinds of therapy that you may have to pay out of pocket for, especially if you are seeking alternative or holistic therapies. You can also use telehealth services, including therapy and counselling, which have become much more common post-Covid.

Equip yourself with knowledge about available emergency mental health services, crisis hotlines, and local resources – there may be support groups in your area that can help you with whatever you are going through. Addiction support groups like AA and NA are common in America and easily accessible.

Pharmacies in the US

You won't have any problem finding a pharmacy in the US. You will find them in hospitals and clinics, grocery stores, large department stores, and more. Compared to pharmacies in other countries, US pharmacies are large and stock a large range of consumer goods. For instance, both CVS and Walmart are considered pharmacies in the United States. They are large retail chains that provide various health-related services, including prescription medication dispensing, over-the-counter medication sales, and health and wellness products – but you can also buy food, alcohol, and various home products here as well.

You should be able to get all the medication you need as an expat in the US. Remember, however, that medication is expensive — this is why it is important to save all your receipts to claim costs with your health insurance provider later.

Note that when it comes to bringing your medication from abroad, the US has very strict regulations. Any medication that you bring into the country should be for personal use only — and you should prove that with a prescription form from your doctor.

Good to know:

Note that some states in the US have decriminalized and allowed for the medical use of marijuana for health purposes. In some states, recreational use of marijuana is also legal. This is why you may see marijuana dispensaries in the city you live in. In the states where recreational use is allowed, you will only need an ID to make a purchase. To buy medicinal marijuana, you will need a doctor's prescription.

Summing things up — you should have absolutely no problem getting quality medical care in the US as long as you have proper insurance and know all the specifics of the country's healthcare system. This is why it is strongly advised to research the healthcare situation in the state you plan to move or travel to.

To learn more about healthcare in the United States, make sure also to read the following articles:

Health insurance in the US

Giving birth in the US

Emergency number: 911: medical emergency, police, and fire brigade.

Useful links:

Medicare web page
Medicaid web page
Official government information on finding health insurance
SSN/ITIN for non-citizens