THE AMERICAN HEALTH INSURANCE SYSTEM

by craftmin | July 16, 2018

On 22 March 2010, 219 members of parliament voted for the bill and thus for the US health reform. 32 million previously uninsured Americans will be able to afford health insurance in the future, partly through government subsidies. Every American now has to take out health insurance. In return, people with previous illnesses can no longer be rejected by the insurance, the socially disadvantaged are treated via a risk pool, “Medicaid” is extended to low-income earners and parents can also insure their children up to the age of 26. The insurance cover must meet certain minimum requirements as a basic insurance (bronze tariff) and can only be acquired in various versions on state-regulated online stock exchanges, so-called “health insurance marketplaces”, for certain periods of time.

So far, the system has worked as follows: The medical care of the Americans is ensured by several separate insurance systems. More than two thirds of Americans receive their health insurance cover through private insurance, the vast majority (approx. 60%) of the US population through their employer and just over 9% through individually acquired health insurance. Only one third of Americans are covered by one of the two major state-funded pillars of the US health insurance system: 13.7% by the Medicare program financed by the German government (Americans over 65 years and disabled) and 13% by the Medicaid program financed by the federal and state governments. The third pillar of the public health system concerns members of the US armed forces and war-disabled veterans (approx. 3.8% of the population). In 2005, 46.6 million Americans were uninsured (15.9%). What the future of Obamacare will look like and in what form Donald Trump will change the reform is unfortunately not yet foreseeable.

 

Compulsory insurance for all US residents

The insurance cover must be verified retroactively from 2015. Persons who refuse to take out health insurance must pay a penalty. In 2016, the fine was US$ 695 (2015: US$ 329) per person, or 2.5% (2015: 2%) of household income, whichever is the higher. The upper limit for this fine is the national average premium for a so-called “bronze” health insurance tariff (basic tariff) of US$ 2,085.

However, American legislation guarantees everyone the right to receive medical care in emergencies, regardless of individual solvency. Uninsured Americans are expected to pay for their own medical care in the event of illness. It is therefore not surprising that the most common reason for personal declarations of insolvency in the United States is doctor’s bills after hospital stays.

 

Group health insurance: HMO and PPO

Healthcare costs in the USA have risen rapidly in recent years, accounting for over 15% of US GDP in 2003 and are expected to double over the next 10 years. Most American employees (and their families) are covered by group health insurance, which is either paid for jointly by the employer and the employee or by the employee alone. Important special forms of group health insurance are HMO and PPO. The term Health Maintenance Organizations (HMO) refers to networks that are also health insurance companies and employ their own doctors. The members pay a fixed premium and are thus entitled to treatment by the doctors of the network. An alternative type with growing market share are the Preferred Provider Organizations (PPO), which allow patients to go to doctors who do not belong to the network. Networks such as HMOs and PPOs are called forms of managed care because they go far beyond pure insurance services.
Compare policies carefully and note that health insurance often does not include dental benefits. You will then need an extra insurance (dental insurance). For economic reasons, American doctors work together more frequently than their German colleagues in joint practices. Among other things, this offers patients the advantage of generous office hours. Many practices are also occupied on Saturday mornings.

 

Visit from Germany: What to do in case of illness?

If relatives from Germany become ill during a visit to the USA, it is usually no problem to get a doctor appointment for them at short notice. The Emergency Room is also always open. However, all invoices must be paid immediately, and if the person concerned has not taken out travel health insurance, considerable cost costs remain which are not reimbursed under the regular health insurance. One can hardly do German relatives a greater favour than to remind them before a trip to the USA to bring along sufficient foreign travel health insurance cover. For holiday travellers, we urgently recommend a temporary international health insurance cover, as a return transport to the home country is also an essential part of the contract in these “packages”.

 

Choosing the right health insurance: What to look out for

For Germans and other EU citizens who intend to settle in Florida or another state of the USA, the choice of a suitable health insurance is an important point. Persons who were legally insured in Germany automatically lose their insurance cover when they leave the European social insurance system. Anwartschaftsversicherung can be continued with the statutory insurance fund.

There are a large number of providers that offer either temporary protection, usually for 5 years with the possibility of extension, or unlimited tariffs. Basically, both options are suitable. It is important to study the relevant insurance conditions. Particular attention should be paid to the following points: