Whether you’re coming on a holiday or moving to the United States to live there permanently, learning how to navigate USA healthcare is essential. The United States has some of the highest healthcare costs in the world and does not offer universal health insurance coverage. For individuals coming from a country with more public healthcare coverage, navigating the US healthcare system can be both daunting and confusing.
Fortunately, we’re here to shed some light on this complicated topic, to help make it easier for you to find the right health insurance option while traveling to the USA. Due to the high cost of even the most basic care, visitors should always ensure they’re traveling with insurance, regardless of whether they plan to be in the USA for years, months, or even days.
The United States healthcare system
The United States health system runs through a combination of public and private healthcare providers and insurers.
Private insurance is offered by employers (which is how most people in the United States obtain their health insurance), but it can also be purchased separately from private insurance companies like Aetna, Blue Cross Blue Shield, and Cigna.
According to the latest census data for 2020, most Americans (66.5%) have private health insurance, while 34.8% rely on public health insurance coverage. When looking at Americans that use private insurance, 54.4% get coverage through their employer, while only 10.5% have directly purchased private coverage.
In the United States, there are two primary public health insurance options: Medicare and Medicaid. We’ll discuss those in depth later. Medicare and Medicaid, along with CHIP (Children’s Health Insurance Program) and other military-focused health insurance options like TRICARE are largely funded with revenues from federal and state taxes.
The importance of healthcare in the USA
Understanding how to obtain coverage for healthcare in the USA is critical. People who enroll in the wrong type of insurance or fail to obtain it entirely are on the hook for their whole medical bill. While many healthcare providers are willing to discount procedures for those without insurance, even that amount can be steep.
This is clearly evident in the case of Duy Hoa Tran, an older Vietnamese man who came to visit his daughter in Los Angeles on what he thought would be a brief visit. Due to the COVID-19 pandemic, he was stuck in the United States, so his daughter purchased travel insurance that she believed would cover his healthcare needs. Unfortunately, they only found out after he had to undergo routine eye surgery that the private travel insurance they purchased did not cover this procedure. As a result, his family was stuck with a $38,000 medical bill.
This type of incident is not isolated to tourists and travelers to the USA. It affects uninsured or underinsured citizens and residents as well. 50% of Americans are currently paying off medical debt, and stories where an individual is saddled with an incredibly high bill for life-saving or medically necessary healthcare are rampant. Even something as simple as a brief emergency room visit can lead to hundreds of thousands of dollars in fees, even for people with insurance.
A guide to the main US healthcare options
In the United States, health insurance is the key to getting care when you need it and protecting yourself from surprise medical bills. Below, we’ll break down some of the options that are available to newcomers to the USA.
Obamacare
Obamacare is the nickname given to the health insurance options available under the Affordable Care Act (ACA). This law was enacted in 2010 and radically changed the US healthcare marketplace. While the law did not change the structure of the health insurance industry, it did make healthcare more affordable by making lower-cost options available to more Americans.
Now, many more Americans are eligible for coverage under the ACA, which can be obtained on the HealthCare.gov website. Plans vary depending on age, location, and other demographic factors, but they generally cover more screenings and essential services than similar plans before the ACA law was enacted.
Medicare
Medicare is federally run health insurance available to all Americans aged 65 and older, as well as younger Americans who have a disability or kidney failure. Most of the time, either the individual or their spouse must have worked for at least ten years in the United States to qualify for Medicare coverage. This includes citizens, as well as legal permanent residents.
You must enroll in Medicare online, over the phone, or in person at a Social Security Administration office. Most people are advised to sign up either three months before or after their 65th birthday.
Medicaid
Medicaid is another public insurance program in the United States. It covers more than 80 million people and was primarily designed to insure those that are lower income. Overall, it accounts for one-fifth of all healthcare spending in the USA.
Medicaid is run and financed in partnership between individual states and the federal government, which means that certain states may offer different standards of coverage.
Eligibility is also determined on a state-by-state basis, which means that people above a certain income level may qualify for coverage in one state but not in another. The easiest way to determine eligibility is to visit the Medicaid website and pick your state to read through the various requirements.
Typically, eligible non-citizens (such as legal permanent residents or those in the United States on a Green Card) must wait five years before enrolling in Medicaid. The only exception is for refugees or asylum seekers.
Employer-based insurance
The majority of Americans receive health coverage via employer-based insurance. This is a private group plan that employers can offer to their staff and their dependents. Most plans are researched and selected by the employer, with the company paying for a portion of the monthly premium.
Unlike other public health insurance options or even ACA coverage, employer-based insurance is available to any individual working for a US company and paying payroll taxes. This type of insurance is an excellent option for any person in the United States, especially those who are on temporary working visas and may not be eligible for other types of healthcare coverage.
Private insurance
Private health insurance is available through various private insurance companies in the USA. While these plans may be similar to employer-based insurance plans, the premiums on independently purchased plans are paid entirely by the individual.
Most often, healthy adults who are over the age of 26 and work part-time, self-employed, or unemployed are the ones purchasing private health insurance coverage.
How visitors and immigrants can navigate the United States healthcare system
Having coverage for healthcare in the United States is essential, regardless of whether you’re coming as a tourist, temporary worker, or legal permanent resident. This will help protect you from the high out-of-pocket costs of American medical care and make navigating the complex healthcare system easier.
Most people traveling to the US who are non-citizens will not be eligible for federally funded options like Medicare, so we recommend purchasing private health insurance coverage. Before making a purchase, do your research to ensure that the option you buy has coverage for everything you need, including prescription medication, regular screenings, and other care that will keep you healthy.
No one wants to spend their entire trip to the United States stressing about a potential accident or injury. Private insurance coverage can help ensure your time in the United States is relaxing and free from worry.
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