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How Does the US Health System Work?

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Health care within the United States is organized in an intricate bureaucracy. While elsewhere in the world, healthcare facilities are controlled by the government or by private sector companies however, in the US the majority of clinics and hospitals is operated by private non-profit groups.

However we must remember that this United States is the country with the highest healthcare costs worldwide. Although these expenses are covered in large part by the public sector, such as Federal institutions or local and state government, they may also be covered by private insurance companies and individual payment.

In addition unlike many developed countries however, it is notable that the US health system is not able to offer health services for all of its inhabitants. Since there isn’t a national health insurance system that is available, it is the United States primarily relies on employers who offer insurance for their employees and dependents.

Furthermore there are programs run by the government which provide healthcare for vulnerable sections of society such including the elderly, disabled and those who are poor. The programs vary from one another and each has a distinct type of person that they are covered by.

The process of getting health insurance in the US isn’t an easy task. Some people believe that once they have money it’s easy simple, but things can be a little more complex. You must be extremely cautious and make sure they pick the correct insurance.

Medical Insurance is available within the United States for non-Citizens

There is no health insurance in the United States. United States government does not offer health insurance to all of its citizens and health insurance isn’t required for residents of the US. It’s optional, but highly recommended and essential since healthcare services are extremely expensive which is higher than in any other nation all over the world.

There are two kinds of health insurances available in the US that are public and private. The majority of people have a mix of both. It is the US state-run health plans include: Medicare, Medicaid, and Children’s Health Insurance Program.

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The US is the country with the highest cost of health care system in the world. It’s the reason why having a good insurance for health is highly strongly.


Medicare is a medical insurance scheme that began in 1966. It covers health insurance for US citizens over 65 as well as those younger than 65 who suffer from end stage kidney diseases, ALS or other impairments.

Statistics show that in the year of 2018 Medicare offered more than 60 million patients with healthcare services in the US and more than 51 million of them older than 65.

Medicare is a program that includes four parts: Medicare program is broken down into four components:

Part A, which includes hospitals hospice, skilled nursing and hospital services.
Part B is for services for outpatients, including services provided by providers while you are at a hospital. Outpatient hospital costs
Part C is an alternative known as Managed Medicare that allows individuals to choose health plans that provide minimum protection as the Parts A and B, with benefiting from Part D and an annual out-of-pocket spending limit that Part A and B don’t have. To sign this section one has to sign in Part B and Part A with a with a fist.
Part D is a broad category that covers prescription medications that are self-administered.


Medicaid is an federal and state-run program that assists people with low incomes and resources in covering medical expenses, and also cover services that are normally not included in Medicare such as nursing personal and home medical services.

It is the most significant source of financing for health and medical services for those with low incomes within the United States. The data shows that the US covered health insurance for those who are disabled or have a low income which amounts to 23% of the US people.

Children’s Health Insurance Program

Previously named The State Children’s Health Insurance Program (SCHIP) It is a program that provides children who are insured by health insurance from families with modest incomes but not sufficient to be eligible for Medicaid.

Obamacare is the Affordable Care Act The Affordable Care Act Obamacare

The Patient Protection and Affordable Care Act an act of the federal government which was signed by President Obama that made it mandatory for each citizen to be covered by health insurance or face penalties. The Act provides subsidies to low-income families through taxing healthcare providers as well as high-income families, since it was designed to reduce the cost of health care while providing higher quality health care to Americans.

The Affordable Care Act permitted parents to add their children up to age 26 to their insurance policies to ensure that healthy children are paying the premiums. The Affordable Care Act also permitted people with lower incomes to receive treatment for chronic diseases rather than relying on an emergency department.

US Private Health Insurance

There are around one thousand private health insurance companies in the US which includes each of them offering plans at different costs, which are mostly based on the person’s medical history. Although there are individual plans which only cover one individual, there are family-oriented plans that target families specifically.

Typically there are three kinds of health insurance that are available in the United States:

Traditional fee-for service health insurance plans that typically are the most costly for those who have less than the average of the US are unable purchasing. But, they are the best options as they provide the most flexibility.
Health Maintenance Organizations (HMOs) which offer a restricted selection of providers for healthcare, however it also provides lower co-payments and will cover the cost of more preventative healthcare. They are rated and certified through the National Committee for Quality Assurance.
Preferential Provider Organizations (PPOs) which are similar to HMOs have lower co-payments, however they provide greater flexibility when choosing the right provider. They offer a selection of providers from which you are able to choose.

How do you choose a good US Health Insurance Plan?

When you are looking the best health insurance policy, make sure to ask questions like:

Does the plan provide you the right to visit any doctor or hospital, clinic, or pharmacy of your choice?
Do specialists like dentists and eye doctors included?
Does the plan cover specific circumstances or treatments, such as the treatment of psychiatric or pregnancy issues, physical therapy?
Does the policy cover nursing home or home care as well as medications that which a doctor may prescribe?
How much are your deductibles? Are there co-payments?
What is the maximum amount you’ll have to pay from your personal pocket to cover my expenses?

It is important to understand how a dispute over services or bills is handled by your service provider and, in certain plans, you could require an independent third party decide on what to do about the issue. We suggest the GeoBlue Xplorer program for people who are foreign living in the United States

Health Insurance requirements for foreign visitors to the US

Although there is no evidence that United States Authorities have not required health insurance for travelers who are traveling to the United States, as Visa holders with B-1 and B-2, it’s strongly recommended that all travelers purchase insurance prior to their visit to the United States.

The most important reason why you should have insurance is the fact that health care in the US is extremely costly and even a simple check-up for simple headache can cost hundreds of dollars and a broken limb could be a huge expense.

Unforeseen health problems are not a thing to be predicted so it’s best to be ready and purchase insurance so that should you need it, you will not be in a pinch.

Optional Health Insurance for Legally Immigrants

Legally present immigrants within America. United States are eligible to receive private health insurance within the US. Additionally, legal immigrants can also be eligible to lower monthly premiums as well as lower expenses out of pocket based on your income.

Individuals with a household income of 400 percent below the poverty threshold or less could be eligible to receive tax credits for premiums as well as other discounts in Marketplace insurance.
If their household incomes that are below the federal poverty threshold of 100% that aren’t otherwise qualified for Medicaid are qualified for tax credits on premiums as well as other benefits in the form of Marketplace insurance, provided that they satisfy all other eligibility conditions.

The majority of the time “qualified non-citizens” can be covered via Medicaid or the Children’s Health Insurance Program (CHIP) in the event that they satisfy the requirements for income and residency of the state in which they reside.

“Qualified Non-Citizens” are categorized as follows:

Permanent legal residents
Asylees or refugees, battered foreigners and their spouses, children or parents who are victims of trafficking , and the spouse of the victim or child, sibling or parent, or anyone who have a pending application to obtain the victim of trafficking visa
Cuban/Haitian entrants,
The parolees who are in US US for at the very least one year
Conditional entry granted prior to 1980
individuals who are who are granted withholding of deportation as well as those who belong to those who are part of a government recognized Indian Tribe or American Indian born in Canada.

However, the majority of them have to wait 5 to five years within the US before they can get Medicaid as well as CHIP protection in the US once they have certified. Refugees and asylum seekers are not subject to the waiting time.

Furthermore states can opt to end the 5-year time limit for waiting periods of children as well as pregnant women to allow them to be covered under Medicare as well as CHIP.

Healthcare Insurance options for illegal immigrants

Illegal immigrants in the US have access to health coverage through private insurance providers since the US health insurance program that is funded by the federal government doesn’t cover them.

Community centers are able to provide medical aid to undocumented immigrants from the US This is known as Security Net Providers, when the patient is eligible to participate in fee-for-service medical assistance.