Guide to health insurance | US Health System: How Does It Work?


The US healthcare bureaucracy is complex. In most of the world, governments or private companies own hospitals and clinics, but in the US, private non-profits do. US healthcare spending is the highest in the world. These costs are mostly covered by federal, state, and local governments, but private insurance and individual payments can also cover them. unlike most developed nations, the US health system does not cover everyone. Since there is no national health insurance system, the US relies on employers who voluntarily cover their employees and dependents.

The elderly, disabled, and poor are covered by government programs for healthcare. Each program targets a specific group. Getting US health insurance is difficult. Money may make things seem simple, but it's not. Selecting the right insurance requires caution.

How Do Health Insurance Deductibles Work?

Your health insurance provider and you contract for deductibles. You agree to pay some of your medical bills, and your insurance provider lowers your premium.

Basic health insurance with a deductible works as follows:

  • You buy health insurance with a $300 deductible.
  • Your initial premium is lower with a deductible package.
  • A $1,000 procedure requires medical attention.
  • The $300 deductible comes from the €1,000 total.
  • Insurance covers the remaining $700 in medical expenses.

You can choose your deductible, or your insurance plan may have one. Discuss this with your insurer before buying health insurance. Insurance companies may not offer deductible plans.

Is a High or Low Insurance Deductible Better?

Your medical condition, medical history, and finances determine the answer. Consider how often you saw your doctor last year and whether you could afford your deductible.

With a high deductible, your health insurance will be cheap. only young, healthy, active people benefit from high-deductible plans. If you get sick often or have pre-existing conditions, a higher deductible will cost you money.

Deductible vs Premium

The deductible is the amount you pay at the doctor, and the premium is the cost of your health insurance policy. Your insurance premium is paid monthly, but your deductible is paid when you get sick.

Example: You buy a $300 a month insurance policy with a $500 deductible. Your health insurance costs $300 per month, but you pay your $500 deductible when you need care. If your medical bills exceed $500 (your deductible), your insurance policy (for which you pay $300 per month) will cover the rest.

Health Insurance Deductible vs. Coinsurance

Some health insurance plans have deductibles and coinsurance. After meeting your deductible, coinsurance means you and your insurance company split medical costs. Your provider can set coinsurance costs in many ways around your preferences. As a general rule, your insurance company pays 80% and you 20%, but this can vary.

Deductible and coinsurance health insurance example:

  • Your insurance policy costs $300 and has a $500 deductible.
  • Your medical bills are $3,000.
  • Your $500 deductible comes first.
  • Pay your coinsurance percentage. This coinsurance rate is 20/80.
  • Insurance covers 80% of the remaining $2,500, and you pay 20%.

With coinsurance, you pay your percentage until a certain amount is reached, then your insurance company pays 100% (out-of-pocket maximum).

US non-citizen health insurance

US citizens are not required to have health insurance. It is optional but recommended and necessary because health services are more expensive than anywhere else in the world.

Private and public health insurance exist in the US. Most combine both. Medicare, Medicaid, and CHIP are US public health insurances. US healthcare is the most expensive. This is why adequate health insurance is advised.


National health insurance program Medicare began in 1966. It insures US citizens over 65 and younger people with end-stage renal disease, ALS, and other disabilities.

Medicare provided healthcare to nearly 60 million Americans in 2018, including over 51 million over 65.

Medicare is divided into four parts:

  1. Hospitals, skilled nursing, and hospice are in Part A.
  2. Outpatient hospital charges and some providers' services while inpatient are covered by Part B.
  3. Part C, also known as Managed Medicare, lets patients choose health plans with at least the same service coverage as Parts A and B, often Part D benefits, and an annual out-of-pocket spend limit. One must sign Parts A and B fist to sign here.
  4. Part D covers mostly self-administered drugs.


Medicaid, a federal and state program, helps low-income people pay for medical treatments and nursing home and personal care services not covered by Medicare.

This is the largest source of funding for low-income Americans' medical services. Data shows that 23% of the US population—71 million low-income or disabled people—had health insurance.

Child Health Insurance Program

Previously known as SCHIP, this program insures children from modest-income families who do not qualify for Medicaid.

Obamacare. the Affordable Care Act

President Obama signed the Patient Protection and Affordable Care Act, which required everyone to have health insurance or be penalized. The Act subsidized low-income families by taxing healthcare providers and high-income families to lower health care costs and improve care for Americans.

The Affordable Care Act allowed parents to add children up to 26 to their policies to get younger, healthier people to pay premiums. It also allowed poorer people to get chronic illness treatment instead of emergency room visits.

US Private Health Insurance

About 1,000 US private health insurance providers offer different plans with different prices, depending on a person's medical history. There are individual plans for one person and group plans for families.

US Health Insurance Types

Typically, the US has three health insurance types:

  • Fee-for-service health insurance. Plans are usually the most expensive, making them difficult for low-income Americans to buy. These plans are most flexible and best.
  • Health maintenance organizations.Has fewer providers but lower co-payments and covers more preventative care. The National Committee for Quality Assurance certifies them.
  • Preferred providers. Like HMOs, they offer lower co-payments, but they offer a list of providers, giving you more choice.

Good US Health Insurance Plans: How to Choose?

Ask questions like these when shopping for health insurance:

  • Does that plan allow you to choose any doctor, hospital, clinic, or pharmacy?
  • Dental and eye specialists covered?
  • Does the plan cover pregnancy, psychiatric care, and physical therapy?
  • Does the plan cover home, nursing home, and physician-prescribed medications?
  • What are deductibles? Are there co-payments?
  • How much will I have to pay out of pocket for expenses?

Make sure you know how your provider handles billing or service disputes, as some plans require a third party to resolve the issue. We recommend GeoBlue Xplorer for US visitors.

US Foreign Visitors' Health Insurance Requirements

The US government does not require health insurance for short-term B-1/B-2 visa holders, but it is highly recommended. Insurance is essential because US healthcare is so expensive. A headache checkup can cost hundreds of dollars, while a broken limb can cost thousands. Health emergencies are unforeseeable, so it's best to be prepared and get insurance to save money.

Legal Immigrant Health Insurance Options

Lawful immigrants can get private health insurance in the US. Lawful immigrants may also have lower monthly premiums and out-of-pocket costs based on income:

  • Marketplace insurance premium tax credits and other savings are available to those earning 400% or less of the federal poverty level.
  • Those with annual household income below 100% federal poverty level who are not eligible for Medicaid can receive premium tax credits and other Marketplace insurance savings if they meet all other eligibility requirements.
  • If they meet state income and residency requirements, “qualified non-citizens” can usually get Medicaid and CHIP coverage.
  • The following are “qualified non-citizens”:
  • Legal permanent residents
  • Asylum seekers, refugees, battered non-citizens and their spouses, children, or parents, victims of trafficking and their spouses, children, siblings, or parents, and those applying for a victim of trafficking visa
  • Cuban/Haitian immigrants,
  • US parolees for at least a year
  • Pre-1980 conditional entrant
  • those granted deportation withholding and federally recognized Indian Tribe or Canadian-born American Indians.
  • Most of them must wait 5 years in the US for Medicaid and CHIP coverage after qualifying. The waiting period is waived for refugees and asylum seekers.

Additionally, states can eliminate the 5-year waiting period for children and pregnant women to receive Medicare and CHIP.

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