How to Choose Best Health Insurance Plan?
On January 1, Donald Trump’s reform repealed the ACA (Affordable Care Act) issued on March 23, 2010. This Act was devoted on affordable medicine and patient protection. The US President ordered all legal residents of the United States to have health insurance. To date, a fine for the lack of insurance is not written up. This can be seen as saving the budget from unnecessary expenses.
However, medical insurance makes it possible to significantly reduce the cost of medical care. After all, bills for medical services can reach $ 300,000, which is why the cost of healthcare services is called the No. 1 bankruptcy cause in the United States.
How does the insurance system work in the USA?
US health insurance is selected based on several criteria. First of all, it is worth determining what category the buyer belongs to:
- a poor person, unemployed. In this case, the insurance will be paid by the state (Medicaid).
- a person with low income and without insurance from the employer. Here, a person who wants to take out medical insurance chooses it himself/herself, but in part, it will be paid by the state.
- a person with an average and higher income and without employer insurance. In this situation, a person chooses medical insurance independently, based on his needs, cost, etc.
- a person with a certain income and with employer insurance. In this situation, the person will have an insurance plan that the employer has chosen.
- people over 65 years old or disabled. It is offered a state subsidized Medicare insurance.
For children, a special insurance program (Children’s Health Insurance Program – CHIP) is provided. Usually, it is either free or very affordable. In some states, it may cover the costs of a pregnant woman.
Basic tariff plans
Depending on the features included and their cost, tariff plans for medical services can be either economy-class or very expensive. 4 main categories are based on the ratio of payment of medical services to the “insurance company/insured person”:
- Bronze – 60%/40%;
- Silver – 70%/30%;
- Gold – 80%/20%;
- Platinum – 90%/10%.
There is also a so-called “Catastrophic Plan,” where the percentage of coverage for healthcare costs from an insurance company is below 60%. It is available to people under the age of 30 or those who have lost insurance. This option is very cheap, but it will save those who want to protect themselves in the event of an extremely dramatic situation.
Regardless of which plan a person chooses, he can count on a discount, since the cost of the tariff also depends on the level of income. Tariff selection can be done online through the website of the US federal government, indicating personal information (state, marital status, income, etc.)
US health insurance options
Each insurance plan has its own combination of options and terms. Before making your choice, you need to clarify all the combinations of the following parameters:
- Insurance premiums. We are talking about a monthly payment on the account of the insurance company, even if there is no medical services provided this month.
- Deductible. In this case, the insured person pays the first expenses for his health care up to a certain amount. After this amount has been fully spent, the case is coped with the insurance company. It is worth noting that some plans do not include this option, or it may not apply to all medical services (for example, exclude coverage of preventive measures, such as vaccinations, etc.)
- Co-Insurance. This option, which may also be included in the insurance plan (or maybe not), allows you to pay a certain percentage of a service, the remaining percentage of its cost is covered by the insurance company.
- Co-Payment. The option makes it possible to pay not a percentage, but a fixed amount for a particular assistance provided (for medicines, for a visit to a doctor, for an examination, etc.).
- Out-Of-Pocket Limit and Annual Limit. The first limits the annual expenses of funds of the insured person by his own, that is, if the amount of expenses for the year exceeded the established limit, the rest is covered by the company. In the second case, on the contrary, a certain amount is fixed, which an insurance organization can pay for a year.
Why are so many options offered for a particular tariff plan?
Insurance companies want to regulate the treatment of their clients so that the latter do not visit doctors for far-fetched reasons and do not waste their money.
On the other hand, it is convenient for a patient with chronic diseases, because it is already clear that visits to the doctor will be frequent and additional financial support will be required. Or, conversely, young students may not spend money on expensive health insurance rates due to their youth and lack of health problems.
Keep in mind: dentistry and ophthalmology always went separately from the general list of medical services. Recently, these two areas have been included in the basic tariff plans, but before choosing a particular medical insurance, it is worth checking these points in advance. In addition, recently more and more often online health care has been included in insurance, especially when it comes to an insurance plan from an employer.