Who pays the insurance
- Your financial and social status is important – it will determine who has to pay the amount of insurance. The following options are possible:
- If you are low-income, disabled, or unemployed, the state pays for coverage (Mediacaid);
- If your income is low and your employer does not pay for insurance, you are responsible, but the state pays part of the cost;
- The most common situation is when your employer pays all or part of it if you work and have at least an average income;
- If you work in the U.S. and have a steady income, but your employer does not pay for insurance, those costs are again your responsibility. This may be due to the specifics of the job.
- And finally, the last case: when you turn 65, insurance is paid by the government under a special Medicare program.
Where and when is the policy issued
You can buy insurance on special Internet resources: a number of states use a federal site, some states have their own. It is there that you can read in detail the main conditions of insurance plans offered by different organizations, and choose the appropriate one for yourself.
Types of health insurance
Now let’s break down the main types of health insurance. All of them can be divided into the following varieties:
Health Maintenance Organization (HMO). These are usually the most inexpensive types of insurance. You choose a general practitioner, who will supervise you in the future (something like district doctors in Russia). It is this doctor who has the right to refer you to more specific specialists. However, you will not be able to get medical care everywhere, only in certain organizations. By the way, it is interesting to know how much a doctor earns under this system of work. Information here. Compare it with the current situation of doctors in Russia.
Exclusive Provider Organization (EPO). Generally similar to the previous type, but in this case there is no attachment to a therapist: you visit doctors on your own. The limits of care are similar to those of the HMO.
Preferred Provider Organization (PPO). This is a more expensive type of insurance, and if you have it in your hands, you get the most favorable health insurance terms. So, you can get care not only from the “basic organizations”, but from almost any medical organization (though usually with a surcharge). There is no need to interact with a therapist: you go to the necessary specialist at the medical institution of your choice on your own.
When you buy one of these types of insurance, you agree to pay the premiums specified in the contract every month. In the U.S., such a premium is called a premium. Its size is usually $200-500 per person.
On the one hand, this may seem rather expensive, but sometimes the cost of operations comes to 20-30 thousand dollars, so it is more reasonable to pay these premiums.
There is another important thing to remember about insurance: sometimes it does not cover the entire cost of treatment. In this regard, we need to distinguish a number of terms, and we will dwell on them in more detail.
Co-pay is a co-pay for medical services. For example, you visit a doctor, pay a Co-pay of $30, and the insurance company covers the rest.
Deductible – A cap on the amount you pay for medical services. The point is this: when your medical expenses reach a certain amount, the insurance company will cover the expenses in the future in a larger amount under Co-insurance (about this below).