Question

How can U.S. health care be made more ethical?

Answer 1

Health insurance is notoriously expensive and complicated in the U.S. Unlike Canada, most of Europe, and many other countries where universal health care provides a basic level of coverage to all citizens, the U.S. has a mixture of private and two kinds of government-run programs. Basic coverage in California and Florida can cost $450 per month, while similar plans in New York can cost upwards of $600 per month.

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The public programs, known as Medicare and Medicaid, are specifically designed for the elderly, people with disabilities, and low-income families and individuals. Everyone else needs to obtain private plans, either through their employer or on their own. Without one, you will still get treated in an emergency, but you are responsible for all of your medical expenses—and the bills can be astronomical.

Even when you do have an insurance plan, you may still get surprise bills. Most insurance plans require you to make co-payments at every doctor, and co-insurance—the percentage you pay alongside your insurer— can come as a surprise to many foreigners who are not used to this system.

How does insurance work in the US?
Private health insurance is either offered through your employer or school, or you have to buy it on your own. You can select a plan that suits you best from the ACA’s Health Insurance Marketplace. The ACA, which stands for the Affordable Care Act—it’s nicknamed “Obamacare”—provides subsidies to those who can’t afford high premiums of insurance plans. The size of the subsidy depends on the individual’s income. Some states like California, Colorado, New York, and Massachusetts run their own healthcare exchanges.

The world of health insurance also has its own language and an extended glossary. It helps to learn a few of the essential terms in order to understand the plan you’re buying:

Premium: The monthly cost of your plan.
Deductible: The amount you pay out of pocket before your insurance kicks in.
Co-Insurance: The percentage of costs you still need to pay after your insurance kicks in.
Co-pay: What you pay the doctor at every visit.
Cost of health insurance varies widely, and it depends on the types of benefits you choose. Usually plans with higher premiums cover more of your medical expenses. In 2018, premiums averaged $440 per month for individuals, and $1,168 per month for families.

How do I get covered?
If you are employed by a U.S. company, you are likely covered through an insurance plan offered by your employer. Some employers pay for the plan in full, while others may pay part of the fee and require you to pay the remaining cost.

If you have a work visa but plan to be self-employed, you will need to purchase health coverage yourself. You can find a plan in the ACA’s Health Insurance Marketplace during the enrollment time, typically running from November to December for the following year.