In this guide we’ve detailed an overview of the United States’ healthcare and health insurance system. This is particularly important for you to understand if you are a new resident in the country.
US Health Insurance System
How Does the Healthcare System Work in the United States?
The healthcare system in the United States is heavily privatized, and citizens and residents need to have private health insurance to pay for their medical costs and services. The government offers only a few healthcare programs for specific members of the population
How Can Foreigners Get Health Insurance in the US?
Foreigners essentially have the following options when it comes to health insurance in the US:
Use health insurance provided by government-run programs (e.g., Medicare and Medicaid).
Obtain health insurance from their employer.
Buy health insurance directly from a health insurance company.
Types of Health Insurance Plans in the United States
Regardless of how you obtain your health insurance, you will find the following most common types of health insurance plans in the US:
- Health Maintenance Organizations (HMOs). HMOs are the type of plans that operate within a network of providers and have certain guidelines. For example, with an HMO plan, you have to visit a primary physician first and get a referral from them to see a specialist. Plus, if you want to visit a healthcare provider outside of the network, your health insurance won’t
- Preferred Provider Organizations (PPOs). PPOs also have a network of providers, and you’re encouraged to visit healthcare providers within that network. But if you don’t, your health insurance still covers you somewhat. Additionally, you don’t need to visit a primary physician first to see a specialist, which gives you more flexibility in your healthcare. However, PPO plans are more expensive than HMOs.
- Point of Service (POS). A POS plan has characteristics of both an HMO and a PPO. This kind of plan allows you to visit other medical providers outside of your network and then be reimbursed by your insurance. However, you need a primary
- Exclusive Provider Organization (EPO). With an EPO plan you’ll have lower monthly premiums for the insurance plan itself but higher deductibles than compared to the other plans. While you are required to visit healthcare providers within the specific network, you don’t need a primary care physician to get a referral for a specialist.
- Traditional fee-for-service health insurance plans. With this type of plan, you or the health insurance company pay the medical provider for every medical service you receive, unlike with other plans that have bundled payments. These types of plans are usually the most expensive, but they also offer the most flexibility.
US Health Insurance for Different Types of Expats
Here are the types of expats in the United States, that should get health insurance coverage:
How to Choose a Good US Health Insurance Plan?
When you’re looking for a health insurance plan in the US, make sure you ask yourself the following questions:
- Does that plan grant you the right to go to any doctor, hospital, clinic, or pharmacy you choose?
- Are specialists such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care and medications a physician might prescribe?
Insurance Cost in the United States?
According to recent data, as of 2024, the average price for employee-based insurance was around $700 per month for individual plans. Those who opted for family insurance plans paid an average of around $1,000 per month.
If you’re buying your health insurance on your own, your personal costs increase since your employer will not be contributing to your health insurance premiums. For example, individuals in their twenties reported to have paid around $400 per month, while those over 50 were around $700.
Of course, the cost will depend on several factors, such as your age, your medical history, the benefits you choose, and so on, but you can always find some affordable options.