If you're planning a vacation or living in the United States (whether for work or study), there's one crucial thing you need to consider: health insurance.
Healthcare costs in America can be very expensive, especially if you don't have insurance. Everything from doctor visits to hospital visits to medications usually has to be covered out-of-pocket.
Well, with health insurance, while there are still costs to cover, they'll be much lower than without insurance.
So, while it's not free, insurance can significantly ease the burden of the exorbitant healthcare costs there.
Here, I'll explain more about the importance of having health insurance in America and what you need to know about it.
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| What's Health Insurance Like in the United States? Let's Find Out! |
Comparing Healthcare Costs in America Without Insurance vs. With Insurance
Now, when we're talking about healthcare costs in America, there are several things that are very important for you to know, especially regarding the cost of the Emergency Room (ER) and several other healthcare services. So, let's discuss them one by one.
ER Costs Without Insurance
According to data from Better Care, ER costs in America can be very expensive, especially if you don't have insurance.
For non-life-threatening conditions, the average ER cost can reach between $1,500 and $3,000, or 25 million to 48 million rupiah (based on an exchange rate of 1 USD = 16,000 rupiah).
If the condition is more critical or urgent, ER costs can immediately skyrocket to over $20,000, or around 324 million rupiah. It's very expensive, right?
Emergency Room Costs With Insurance
Well, if you have insurance and have met your deductible (I'll explain this further later), your ER costs can be much lower.
According to data from Better Care, the average out-of-pocket cost for an ER with insurance is around $500, or around 8 million rupiah.
Of course, this cost can vary depending on your insurance type and your health condition, but it's definitely much more affordable than without insurance.
Uninsured Childbirth Costs
The cost of childbirth in America can also be surprising, especially if you don't have insurance. According to data from Wise, the cost of giving birth in a hospital without insurance can be very expensive.
For a vaginal delivery, the average cost is around $30,000, or almost 500 million rupiah, while a cesarean delivery can reach $50,000, or around 800 million rupiah.
Childbirth Costs With Insurance
If you have insurance, the cost of childbirth becomes much lower. Based on the same data, for both vaginal and cesarean deliveries, the average out-of-pocket cost after insurance is around $3,400 or around 55 million rupiah.
Of course, this cost can vary depending on the type of insurance and whether or not you meet the deductible.
Cost of an Urgent Care Clinic Visit Without Insurance
Visiting an urgent care clinic (a clinic that treats urgent but non-emergency medical conditions) can also be quite expensive without insurance.
According to data from GoodRX, the cost of an urgent care visit can range from $125 to $300 (2 million to 5 million rupiah), depending on the type of care needed.
Cost of an Urgent Care Clinic Visit With Insurance
Most health insurance plans in the United States cover urgent care visits. Typically, you only need to pay a copay, which averages around $75 (1.5 million rupiah) per visit.
But, again, these costs can vary depending on the type of treatment and condition, as some treatments and conditions are not covered by insurance.
Now you should understand the importance of having health insurance in the US. Next, I'll discuss in more depth other important things you should understand about health insurance in the US.
Things You Need to Know About Health Insurance in the United States
Before you choose or purchase a health insurance policy in the United States, there are several important things you need to know.
Because each insurance policy can be different, it's crucial to read and understand every detail (fine print) of the insurance policy you choose.
1. Terms Frequently Used by Insurance Providers
Health insurance in the United States uses specific terms that you should understand thoroughly, as this will give you an idea of what the insurance covers and how much out-of-pocket you should prepare.
Here are some of the main terms frequently used in health insurance in the United States.
I'll explain them in an easy-to-understand way, so you won't be confused later when reading your insurance policy. These aren't all the terms, just the most important ones:
– Deductible (Annual Out-of-Pocket Limit)
The deductible is the amount you must pay upfront before the insurance begins covering your medical expenses for a year.
For example, if your deductible is $500, you must pay up to $500 in out-of-pocket medical expenses before your insurance will cover further medical expenses.
However, the lower the deductible you choose, the more expensive your monthly premium will typically be.
It's also important to note that not all benefits are included in the deductible; the policy will usually state "not subject to deductible."
- Copay (Fixed Fee per Visit)
A copay is a fixed fee you pay for services covered by your insurance.
For example, if your copay is $20 for an urgent care visit, you only pay $20 when you visit the urgent care clinic.
The rest will be covered by your insurance, as long as the condition being treated is covered by the policy. If the condition or illness is not covered by your insurance, you will have to pay the full amount.
Coinsurance
Coinsurance is the co-payment you share with your insurance company after you've met your deductible, usually as a percentage.
For example, if your coinsurance is 20% and your total medical expenses are $100, you'll pay $20, and the remaining $80 will be covered by your insurance (as long as you've met your deductible).
However, if your deductible hasn't been met, even if you have coinsurance, you'll still have to pay the full cost of your medical expenses. So, if your deductible is $200 and your medical expenses are $100, you'll still have to pay the full cost, even if you have a 20% coinsurance.
- Allowed Amount or Maximum Coverage
This is the maximum amount your insurance company is willing to cover. For example, if your insurance has a maximum coverage of $50,000, but your medical expenses are $60,000, you'll have to pay the difference of $10,000.
When purchasing insurance, make sure you choose a maximum limit that suits your needs.
– Out-of-Pocket Limit
The out-of-pocket limit is the maximum amount you must pay before your insurance will cover your medical expenses, up to the maximum limit stated in your policy.
This only applies to conditions covered by the insurance and does not include your monthly premiums.
Some insurance companies also exclude copays, coinsurance, and deductibles from your out-of-pocket limit, so it's important to understand this so you know how much you'll likely incur in a year.
2. Not All Hospitals or Doctors Are Covered
In the United States, almost all health insurance plans have a list of healthcare providers (in-network or preferred providers).
This network includes various doctors, hospitals, pharmacies, specialists, urgent care clinics, and other healthcare institutions that have agreed to provide services at a lower cost to policyholders.
So, before you go to a doctor or hospital, it's important to research whether the doctor or hospital you're planning to visit is included in your insurance company's network.
Why? Because if you go to an out-of-network facility, the cost can be significantly higher.
In fact, if you're referred to another doctor or facility, and the referring doctor is already out-of-network, they'll likely recommend one that's also out-of-network, which will automatically increase the cost.
But this doesn't mean you can't go to an out-of-network facility. You can, but you'll just have to prepare extra funds.
Some insurance policies also offer out-of-network benefits, so check with your insurance company first. You can also ask the healthcare facility you're considering directly if they offer special discounts for patients.
3. Not All Illnesses Are Covered by Insurance
Health insurance in the US has different provisions regarding the illnesses or conditions they cover.
This is especially important to remember, especially if you have certain medical conditions. Some common exclusions in health insurance policies are:
Pre-existing conditions. Many policies don't cover medical conditions that existed before you were covered. For example, if you already had a certain condition before enrolling, treatment costs for that condition may not be covered.
Dental. Health insurance in the US generally doesn't cover dental care, such as routine dental visits or special procedures. Dental insurance can usually be added as an add-on, which can increase your monthly premium. However, dental emergencies are usually included in your insurance policy. Check with your insurance company to find out for sure.
Vision. Just like dental care, eye insurance is generally not covered unless you purchase it as supplemental insurance. The exception is emergencies, which are often already included in regular health insurance policies.
Mental Health. Treatment for mental health issues, such as depression or anxiety, is often not covered by regular health policies. If you feel this is important, make sure your policy covers mental health care, or you can also look for a plan specifically for mental health.
Extreme Sports or Activities. If you enjoy extreme activities like boxing, diving, paragliding, or rafting, be sure to read carefully about what is and is not covered, as some high-risk activities are not always covered.
4. Some Insurance Plans Have a Waiting Period
Some health insurance plans in the US have a waiting period before you can start using them. This is usually around 30-90 days after you sign up. However, this also depends on the type of insurance and the provider.
Always read the details of your policy. Don't be surprised if you suddenly need treatment, but find that you can't use it because there's still a waiting period.
Where Can You Get Health Insurance in the United States?
Getting health insurance in America depends largely on your purpose for coming there. Let's discuss each one.
1. For Students
Your university or school usually provides health insurance for international students before you arrive in America. However, if they don't, you can check out some international student insurance options on this website:
International Student Insurance
2. For Employees
Most companies provide health insurance as part of their employee benefits, and the premiums are deducted from your paycheck.
However, if your company doesn't offer insurance, you can try finding one yourself. Here are some options:
Path2USA: Insurance for H1 Visas
Visa Guide: H1B Health Insurance
If you have lived in the US long enough and qualify as a resident alien for tax purposes (see the Substantial Presence Test for more details), you can purchase insurance from the Marketplace at:
Note: The Marketplace is only open during the open enrollment period (early November to mid-January each year) unless you qualify for the Special Enrollment Period.
3. For Travelers
If you are visiting the US for vacation, you can choose travel insurance that covers health. One option is through this site:
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