Healthcare for Expats Living in the United States of America
As the most powerful nation in the world, the United States of America has access to the best of almost everything. Despite that, the country does not have a universal healthcare system, which is present in almost every other developed country. Instead, it has a hybrid healthcare system that is supposed to cover every US citizen in some form or the other.
Those who have foreigner health insurance can choose a primary care provider (a physician or a nurse) from within the insurance company’s network. To meet your chosen primary care provider, you have to make an appointment first. After that, you have to wait for a few hours or weeks depending upon your reason to seek the appointment. Those stuck in emergencies can get medical care immediately.
Overview of the Healthcare System in the USA for Expats
The U.S.A. healthcare sector is estimated to be worth over $3 trillion. It is so big that it would be the fifth-largest global economy if ranked as a country. On average, every household in the country has to pay more than $8,000 towards healthcare. Yet, despite being more than twice as costly as the next most expensive healthcare system, the US ranks 37th among the best healthcare systems in the world, as reported by the World Health Organization.
In most states, it is not compulsory for expats to have insurance; however, without insurance, they can only access a somewhat mediocre healthcare system that also becomes completely inaccessible at times. It is not uncommon for anyone who is not insured in the USA who suffers a major illness or injury to be saddled with enormous medical bills and even become bankrupt. There are also lots of stories of expats and people traveling to the USA without medical care who after becoming sick or injured have incurred large medical bills in the hundreds of thousands or even over a million.
Expats moving to the United States need international health insurance that comes with comprehensive coverage to help avoid financial ruin and access medical care. An insurance plan gives expats access to leading private hospitals in the US that are regarded among the best in the world. Expats don’t qualify for federal medical aid schemes. However, they can buy insurance themselves or get the company they work for in the US to make some contribution to their private health insurance plan. They may even be able to get on the employer’s group benefits plan.
If you are 65 or over in the USA, you may be eligible for Medicare, which provides a decent amount of medical care. However, most Americans will purchase supplemental coverage to fill the gaps. Expats should not expect to be eligible for Medicare coverage.
Finally, most local plans in the USA often have very large deductibles, coinsurance and of course premiums.
Obamacare – Affordable Care Act & Expats
The Patient Protection and Affordable Care Act (PPACA) is often referred to as Obamacare and was signed by President Obama in 2010. Obamacare works by mandating that everyone get health insurance or pay a tax penalty. The idea was essentially to get both sick and healthy people to both be insured and provide a viable pool of insured people for insurers while mandating a minimum and essential level (MEC) of coverage and most importantly cover pre-existing conditions.
The Republican Party and President Trump have steadily chipped away at the law. The federal tax penalty for not being enrolled in health coverage is supposed to be removed in 2019 because of recent changes made by the Trump Administration – but check with your tax advisor if you are an expat in the USA.
In our opinion, it is highly unlikely that an expatriate moving to the United States will be eligible to access an ACA compliant plan. To be eligible to enroll in an ACA plan, you will at least have to have a social security number and established residency in a US state. You will have to check each state’s rules to see if you can enroll in a local health plan in the USA – but that plan will most likely only cover you locally. Contact us to see if you can qualify for an ACA compliant expat plan or regular expat health plan in the USA that required medical underwriting.
Healthcare Facilities and Standard of Care in the USA
Most of the American hospitals are privately owned and managed by investor boards and non-profit associations. The standard of care in these hospitals is excellent and waiting times are short. Those who can afford private treatment can access the best of medical technology for treatment. There is a federal medical aid scheme too, which caters to the elderly, people with low or no income, and children.
Expats who have international insurance and undergo treatment in an American hospital should retain all the receipts so that they can make a claim later on. Also, expats who want to settle in the US need to undergo a medical test and show the report for administered immunizations. Those who don’t meet the criteria would need to take the medications during the medical test.
Medical Network in the USA: If you are planning to obtain care in the USA or be covered for medical insurance in the USA. It is important to check if the global health plan you are buying will cover you in the USA and has access to a large medical network in the country. A high-quality expat provider should provide the option to add access to medical treatment in America. Which is important for American expats and those wanting to access care there. Most plans will automatically include USA medical coverage if you are an expat living in the USA or are noting in the quote page that you will be living there. Access to a high-quality medical network will allow you and your family members to access medical care and get claims paid directly to the hospital or health facility.
Medicines and Pharmacies
Medications in the US are available at all the pharmacies and various grocery stores based in the US cities. Expats can easily procure prescribed medicines from American pharmacies. Since medications are expensive, foreigners health insurance bought earlier can help with the incurred costs. If expats have to make an upfront payment, they can collect all the bills and then present the same to the insurance company to file a claim.
Top 5 Things Expats Should Know about the Health System in the USA
We have compiled a list of the top 8 things that foreigners should know when accessing medical care in the USA:
- Provider Networks are Critical: Most hospitals, clinics, doctors and even pharmacies are part of various provider networks and you should be able to find a list via their customer website. Most plans will give you a break on deductibles and coinsurance if you use their network as it saves them at claim time.
- ER Costs are Expensive: Note that in the USA, a visit to the emergency room is extremely expensive. If it is not an emergency, think about seeing a GP or going to a clinic.
- Prescription Drug Costs: Getting medication in the USA is very costly, but the range of medicines and service are first rate. Maybe ask your MD if a generic medication will work just as well as a brand medication.
- Billing is Complex: U.S. medical billing can be complex, with multiple bills for a single treatment.
- Telemedicine is Available: A lot of expat insurance plans now cover telemedicine as this allows for advice and support on non-urgent and serious matters. It is convenient and easy.
- Expect High Deductibles: If you are in the USA you should assume you will have a large deductible and coinsurance to keep cost down, especially if you go outside the medical network.
- Medical Coverage is Critical: As noted, several times, you don’t want to be in the USA as an expat and not covered. Make sure you get the best possible coverage for emergencies and non-emergencies. If you are only in the USA for a short time period, think about travel medical insurance.
- Premiums are Higher: If you are going to buy healthcare to cover you in the USA, expect a much higher cost.
- Specialists Require a Referral: Note that some health plans will require a referral from a GP to see a specialist.
- Medical Care in Cities: Note that like most countries the medical care you get in a city will be better than if you are in a rural area.
Emergency Services in the US
Your first action in case of an emergency should be to call 911 (the number for Emergency Medical Services in the US). If you have kids, educate them on only using this number in case of a dire emergency. Such emergencies include life-threatening situations where even you may have to intervene until the ambulance reaches your location.
Note that the United States has some of the best medical emergency services in the world, but that comes with a high cost.
Best Private International Medical Insurance Plans for Expats in the USA
The law in the United States makes it mandatory for every hospital to provide treatment to American citizens. The difficult part comes when the citizens have to pay the hefty bills incurred from such treatments at the hospitals. On several occasions, people don’t go for the medication because of the costs involved. To avoid such situations, expats can get a comprehensive international health insurance plan. It is just as important to buy insurance from a reliable company as the treatment itself.
The best global health plan that we offer to individual expatriates living in the United States is the Cigna Global Health Options plan. Depending on your situation and if you have a green card while living in the USA, we might even be able to source an ACA (Affordable Care Act) plan which meets the Obama Care compliant coverage. Contact us for more information and to discuss your requirements.
Check out our article on what the top options for expat health insurance in the USA?
