Many people going to the United States have a good understanding of the social system and cultural life, but they have only a vague understanding of healthcare insurance. In response to this situation, the immigration editor from WorldWay Immigration will discuss the most common healthcare insurances in the United States, introducing their characteristics and which type of insurance is more convenient for medical treatment.
Everyone knows that the medical process involves both patients and doctors. Regardless of the type of insurance you have, understanding the doctors' perspectives may help you choose healthcare insurance and facilitate smooth medical treatment. The healthcare insurance system in the United States is very complex, mainly consisting of two parts: social healthcare insurance and private healthcare insurance.
Social Healthcare Insurance
The United States Congress passed the Medicare Act in 1965, authorizing the government to establish social healthcare insurance. This mainly refers to the "Medicare" insurance (red card) managed by the federal government, primarily targeting retired seniors and individuals with disabilities, and the "Medicaid" insurance (known as the white card in California) operated by state governments for low-income residents. Additionally, veterans can apply for Veterans Affairs healthcare insurance (VA).
The above is the Medicare card from the federal government, which is popularly referred to as the red card among the Chinese community. Medicare consists of two parts: Part B, which covers doctor fees, and Part A, which covers hospital fees. The basic eligibility requirement for applying for Medicare is being a U.S. citizen aged 65 or older or a green card holder who has lived in the United States for at least five years (along with other conditions). Medicare covers retired seniors, individuals with disabilities, and patients with kidney disease requiring long-term dialysis. There are no income restrictions for applying for Medicare, but a monthly premium must be paid, and after receiving medical services, there are deductibles and coinsurance.
The above is the Medicaid card for low-income individuals in California, which is white in color and is therefore referred to as the white card. Medicaid varies slightly from state to state in the United States, primarily covering low-income pregnant women, children and adolescents under 19, seniors aged 65 and older, the blind, and elderly individuals requiring nursing home care.
Medicaid beneficiaries enjoy free medical services, but their identity, age, residency duration, income, and assets must meet specified conditions. Due to the current economic situation in the United States, applying for this type of insurance is becoming increasingly difficult. Many retired seniors who come from China with sponsorship from their children have obtained Medicaid.
Some seniors or individuals with disabilities may simultaneously meet the eligibility criteria for both Medicare and Medicaid. These patients can enjoy dual coverage from Medicare and Medicaid. Patients covered by Medicare need to pay monthly premiums, deductibles, etc., but if they also have Medicaid, the state government will cover these costs. In the current situation, these individuals do not need to spend any of their own money when seeing a doctor, being hospitalized, or residing in a nursing home (most patients actually have no money). From the doctors' perspective, since they have dual coverage, patients do not have to pay, which increases patients' willingness to see doctors, leading to more consultations and higher income for doctors. Many doctors prefer patients with Medicare and Medicaid. Medicare and Medicaid are collectively referred to as Medi-Medi and are often called "gold cards" by many doctors and patients.
Private Healthcare Insurance
Private healthcare insurance in the United States is operated by private insurance companies, mainly including PPO (34%) and HMO (31%). PPO stands for Preferred Provider Organization, and its advantage is the freedom to choose doctors. There is no need for a primary-care physician (PCP) referral; patients can directly see specialists. The main issue with PPO is that the insurance premiums are relatively high, and patients must bear part of the co-payment (ranging from $15 to $30) when seeking medical care. Each year, before the insurance company pays for medical expenses, patients must first pay between $250 and $1,500, meaning that PPO has deductibles and coinsurance.