The US Health Care System Explained

The US Health Care system is undergoing radical changes since the introduction of the Patient Protection and Affordable Care Act brought in by Barack Obama and which became law in March 2010. This aims to drastically cut down the number of Americans without health insurance by offering tax credits and subsidies to employers and individuals to encourage people to get insured.

It also aims to force insurance companies to offer affordable rates for all regardless of any existing health conditions and penalise employers who fail to provide health insurance.

So what about expats moving to the US? Assuming that you can afford health care insurance, here is a brief guide to health care in America.

US Health Insurance

Most Americans are insured through their employer, some are enrolled in a public insurance program whilst others buy insurance direct. Public-run health insurance is owned by the government. The two largest public insurance companies are Medicare and Medicaid which offer cover to the elderly, poor, people with disabilities, end-stage renal disease and ALS – a form of motor neurone disease.

Private US health care coverage is often provided by employers through an employer sponsored program. The employer makes a contribution towards costs (around 85%) and the employee pays the rest. This insurance also covers dependents but there is a Children's Health Insurance Program for uninsured children whose parents aren't covered by Medicaid.

Self employed people have to purchase their own insurance although they do receive a tax deduction and other incentives. For all those going private, the consumer has to pay the full cost of contributions but because of the Patient Protection and Affordable Care Act and also the increasing competition in the private sector, the prices are broadly spread.

US Health Care Facilities

The majority of hospitals are extremely well equipped and non-profit but there are also privately owned hospitals and government owned facilities, with some government owned hospitals only open to army personnel.

There are specialised medical centres and clinics in every state such as the John Hopkins Hospital which specialises in neurosurgery, paediatrics, cardiac surgery, urology, endocrinology and child psychiatry. Hospitals will usually advertise their specialist services and it's up to you to choose which hospital to be treated in.

If you are in need of a doctor it's best to find one affiliated with your health insurance plan – your provider should have a list. Make sure you know where your nearest doctor is before you become unwell! Doctors, as well as hospitals, often specialise so you may well find separate male and women's clinics as well as children's clinics. You should choose your dentist in the same way.

Doctors in the US tend to be much more thorough than in the UK due to fear of litigation so be prepared for many tests (carried out on the premises most of the time) instead of just a prescription. Regular check-ups are common.

You will be invoiced for treatment which you should double-check before sending it to your insurers.

Most town centres and supermarkets have walk-in centres for minor complaints but be prepared to pay in advance for these.

Be warned that if you neglect to sort out your health insurance before moving to the US you could be faced with huge bills should anything go wrong. Don't assume your employers are providing insurance – find out!

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