Health Insurance in the USA

Health insurance in the United States is a patchwork of private providers and government programs. This guide will guide you through the complex system of American health insurance and give you important tips for finding the right offer.

The healthcare system in the USA

The US healthcare system is unique in the world. There is little government regulation, but a wide range of private providers. US citizens who are not covered by government programs are responsible for their own health care. Unlike in most other industrialized countries, however, health insurance is not compulsory in the USA.

US government health insurance dates back to the Social Security Act, which was passed in the 1930s in response to the Great Depression to protect Americans from poverty in old age.

With the creation of Medicare and Medicaid in 1965, social security systems were extended to include health care. However, only certain groups of people benefit from the programs of the national health insurance in the USA

Medicare

Medicare ensures the medical care of seniors and seriously ill people. Any US citizen age 65 or older is eligible for government health insurance benefits. Additionally, individuals with a recognized disability or acute kidney failure are protected under the Medicare program.

Medicaid

The Medicaid care program is also part of the US national health insurance system. These are benefits similar to social assistance, with which children and people with low incomes in particular are supported. To receive Medicaid benefits, Americans must pass a means test.

Tricare

Tricare, the US Department of Defense health care program, is the third pillar of US government health insurance. It also originated in the 1960s and provides civilian healthcare services to current and former US military personnel and their dependents.

Private health insurance in the USA

Most Americans have private health insurance through their employer. As a rule, these are group health insurance policies, some of which are paid for by the employee themselves and some by the employer. In some cases, however, employers only offer health insurance and the contributions are borne entirely by the employees.

A major disadvantage of this form of insurance coverage is that it is tied to the employer and is often terminated if you lose your job. If you are unable to insure yourself through your employer, you must take out your own private health insurance.

Problems in the US healthcare system

There is generally little government interference in the health sector in the United States. The market is more determined by economic interests. Of course, this brings with it a number of problems.

On the one hand, the United States is known for very good and modern equipment in practices and hospitals, but they are also feared for their extremely high healthcare costs. Medical treatments and medicines cost significantly more in America than in other industrialized nations. This in turn leads to high health insurance costs in the USA.

Different insurance companies offer very different ranges of benefits. Cheaper policies often don’t cover all treatments, leaving many Americans underinsured. Around 29 million citizens even choose not to take out health insurance at all.

Doctors and hospitals are required by law to treat uninsured patients in emergencies. In such a case, the patient has to pay the costs out of their own pocket, which often leads to horrendous debts. Medical treatment or hospital stays that cannot be paid for are the most common cause of personal bankruptcies in the USA.

High healthcare costs in the US

The high cost of health insurance in the US is due to several factors:

Rising drug prices

Drug prices in the United States have continued to rise since the 1950s. Today, prescription drugs in the US cost more than 2.5 times what they cost in other developed countries. American pharmaceutical companies cite the high costs of medical research and the development of new drugs as the reason for the rising prices.

Possible lawsuits

Hospitals and medical practices in the USA are free in their pricing. Losses from possible future lawsuits for compensation payments are already taken into account. Therefore medical treatment in the USA is very expensive. Even simple products like handkerchiefs or plastic cups are given a hefty price tag in American clinics.

Postponed Treatments

Since many Americans have no or only insufficient health insurance, medical examinations and treatments are often avoided or put off in order to save costs. However, this can lead to diseases going undetected and worsening. In the long term, this means even higher treatment costs in many cases.

Unhealthy Lifestyle
Many Americans eat unhealthily and do not exercise enough. According to the US Centers for Disease Control and Prevention (CDC), approximately 42% of adults in the US are obese. Being overweight leads to an increasing number of chronic diseases such as arthritis or so-called lifestyle diseases such as type 2 diabetes. The resulting treatment costs represent a further burden for the American health system.

Health insurance for US expatriates

Getting health insurance is a key item on the to-do list for anyone embarking on a project to emigrate to the United States. Since the American market for health insurance is very diverse and opaque, it is advisable to take out international travel health insurance for the first time and then take your time to look for the right offer

A useful source of information is the US Government Marketplace. It was created with the enactment of the 2010 healthcare reform, better known as “Obamacare”. US citizens and permanent residents, as well as holders of other visas and residence permits, can find suitable insurance coverage on the website.

Many health insurance plans in the US do not cover all services. So e.g. For example, additional dental insurance is often necessary for dental treatment. Therefore, before signing a health insurance policy, any offer should be carefully evaluated to ensure that it meets your needs.

Before purchasing private health insurance in the United States, ask yourself the following questions :

• Are medical practices, hospitals, and pharmacies freely selectable, or is the offer tied to specific facilities?
• Does the offer include all prescription drugs or are there any restrictions?
• Does the offer include medical treatment by specialists (e.g. dentist, ophthalmologist)?
• Does the offer cover home health care costs or nursing home costs?
• Does the offer include special treatments such as physiotherapy or psychiatric care?
• Are there deductibles or co-payments and how high are they?