Good health insurance is pretty much a necessity in our times. The cost of healthcare has been on the rise all around the world. Insurance helps avoid unreasonably large healthcare bills during times of need. Here is a look at some considerations for expats in the US to get adequate, affordable, and reliable health insurance.
The Affordable Care Act
The public healthcare framework in the US was reformed under the Patient Protection and Affordable Care Act (PPACA), more commonly known as ACA or Obamacare. The reform brought standardization to insurance benefits. Policies are required to offer “essential health benefits” including cover for emergency services, hospitalization, laboratory tests, and prescription drugs. An employee who works for more than 30 hours per week in an organization that employs 50 or more is eligible for ACA-compliant health insurance.
In the US health insurance is no longer mandatory as per a new law effective from January 1, 2019. Only a few states such as California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont still impose penalties for not having health insurance. It is important for expats to check if their state of residence mandates individual health insurance. In states that mandate such insurance expats must subscribe to ACA-compliant policies. Elsewhere, any non-ACA compliant local or international health insurance would do. Travelers to the US are not affected by the ACA. However, it is advisable to buy travel health insurance to offset the risk of any eventualities abroad.
Public healthcare – Medicare and Medicaid
Medicare is a social insurance program for people with disabilities and for seniors aged 65 or more. Medicaid is the insurance program for people in the low-income group. According to the US Census Bureau, 57 million people enrolled for Medicare worth $750 billion in 2018. Another 66 million enrolled for Medicaid worth $616 billion.
Private healthcare
Private health insurance is the primary form of health coverage in the US. Private insurance can be purchased by organizations for their employees. Individuals can also buy private health policies for themselves. In 2018 private health insurance firms sold policies worth $1,243 billion. The 2 most common types of health insurance plans in the country are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Individual private medical insurance policies can also provide international cover. Tax-paying expats in the US can opt for both ACA and non-ACA policies. Business travelers to the US can buy suitable plans to match their length of stay in the country.
International health insurance
International healthcare insurance is generally the most suitable option for expats. Unlike national policies, international healthcare insurance covers expenses incurred in any part of the world. Insurers offer ACA-compliant and non-ACA-compliant international policies.
Foreign students can often benefit from specifically designed insurance packages. Some US universities offer such plans. For example, students who gain admission to the University of Kentucky are automatically enrolled for the school’s student health plan. The cost is included in the fee. Another example is the University of Virginia, which partners with healthcare company Aetna to offer suitable insurance policies to students. The average annual cost of such insurance plans is $2,980.
Eligibility
Expats in the US are eligible for Medicare if they qualify to receive Social Security Retirement Benefits, Railroad Retirement Benefits (RRB), or Social Security Disability Insurance (SSDI). Permanent residents and green card holders enjoy access to discounted insurance plans. Individuals with non-immigrant status, asylees, refugees, victims of trafficking, and lawful temporary residents can purchase private health insurance plans. Those who do not fall in any of these categories can approach private insurers for short term medical and accident insurance. Under federal law people with no insurance are also eligible for emergency care. Community health centers and Federally Qualified Health Centers need not ask about immigration status to provide non-emergency health services.
Cost
US residents have access to high quality medical care. However healthcare costs in US are among the highest in the world. On average the cost of visiting a general practitioner is $90 with insurance and $230 without insurance. This makes health insurance essential. Non-ACA compliant health insurance policies are usually cheaper than ACA compliant plans. According to expat assure, a trade name of Leprêtre Insurance Services Limited, an ACA compliant health insurance policy for a 39 years old woman would cost $21,000 per year. A non-ACA compliant policy for the same person would cost $7,600-10,000. This should be an important consideration for expats whose primary goal is to save and transfer money back to their families via remittance channels.
In order to contain costs each US health insurance company prefers to work with its defined group of partner hospitals and medical professionals. Some insurance companies allow policyholders to choose hospitals outside their defined network. However this can attract additional costs in various forms.
