Health Insurance American


What you should know about health insurance in the United States. Americans do not have the equivalent of The (French) Social Security. The vast majority subscribe to private insurance which covers the risks related to their health. But how does it work in practice?

The different types of health insurance

First of all, we must know that the healthcare system in the United States is private, of the mutualist type, which means that everyone contributes to an insurance plan according to his means, of course, but also to the risks of Health he wants to cover. Thus, there is something for every taste and every purse, insurance very expensive ... the lack of insurance. In the latter case, MEDICAID, a public health insurance scheme, can help the most deprived. Similarly, if you are over 65 and you or your loved ones can not meet your medical needs, there is the MEDICARE system of national solidarity, financed by income taxes. Next, you should know that there are three kinds of health plan in the US, PPOs, HMOs and I I:

Preferred Providers Organizations (PPOs)

They are private insurance companies which provide employees, through the company that employs them, with benefits and reimbursements "comparable" to the european systems, provided that the patient refers to the practitioners and hospitals of the network defined by the company. The members of this network are Liberal physicians who have entered into a fee agreement negotiated with the insurance company. Note that in this type of plan, the contribution borne by the employer is collected in a Health Savings Account, completely tax-exempt! PPOs are widely used in the United States, even by self-employed self-employed persons.

HMOs (Health Maintenance Organizations)

They bring together under the same entity, the insurance company and the health care system. Sometimes, the health worker is employed by the company, sometimes it is remunerated to the act and can manage a personal patient.

The I I (Indemnity Insurances)
They are genuine private insurance companies, which offer their services, independent of any wage activity, and operate solely to the probability of realization of the damage.

Concretely…
All insurance is not equal. When we learn that medical bills are the primary reason for personal bankruptcy in the United States, it is imperative to study, first, what is covered ... and what is not; Especially since the implementation of health insurance can take several weeks. Small lexicon to help you understand:

Copay: Amount that is still in our charge (even if we are insured) and that we pay every visit to the doctor (about 20 Dollars).
Out of pocket maximum: Maximum ceiling of what one might have to get out of our pocket.
Deductible: Deductible, that is to say from how much the insurance begins to repay.
Coverage and exclusions: Risks covered and Not covered by insurance.
Network: Network of health professionals (see PPO).
Out-of-network: Doctors outside the network (see PPO).
Out-of-network coverage: Insurance coverage when visiting an off-grid practitioner (PPO case).
Pre-existing condition: If the diagnosis of a disease is prior to the signing of an insurance contract, an insurance company has the perfect right to refuse health coverage due to this pre-existing disease. But it can not, on the other hand, break an existing insurance contract. In other words, if you want to change health insurance, make sure that you are covered continuously during the transition period (by either one ...). It is this problem of pre-existing conditions that the recent reform of President Obama is trying to address.

If you are self-employed, you can choose to take a PPO or an HMO, knowing that you will have to pay a contribution of about $ 1000 / month for good coverage (based on a family of 4). You can visit the website
eHealthInsurance.com  useful for comparing different health plans online.

Good to know - Special low budget:

If you need health coverage, you have some free time, and your budget is very tight, then go back to college!

By enrolling in a weekly course at Community College, you will be eligible for HMO-type coverage as a student. There are disadvantages: care is covered at 80% and there is a ceiling for the hospital, insurance varies according to the universities, you can not always go to the doctor of your choice ... Always better than nothing! And then art history courses that cover you medically, it does not refuse ?

Also, visit the site

GatewayPlans.com, specializing in short-term health insurance, for periods ranging from 15 days to 36 months. Likewise, the site RxAssist.org gives valuable help on the cheapest prescriptions, generics, etc. Another little lexicon, well useful to the doctor:

• Prescription: Ordinance.
• Prescription drug: Prescription drug.
• Primary physician: Your primary physician.
• Provider: Doctor or specialist (terminology of health insurance companies).
• Over-the-counter [drug] ( "OTC"): Open Access Drug.

Reform of President Barack OBAMA - "Patient Protection and Affordable Care"

Voted in 2010 and found to be in conformity with the Constitution 2 years later, the Obamacare health insurance system is adapted to the middle class, which was not included in the "Medicare" reserved for the poorest but could not Subscribe to too expensive private health insurance.

The Affordable Care Act is mandatory: Americans are now obliged to have health insurance; Those who do not have to pay a fine. Anyone who has not taken out health insurance as of May 1, 2014 will then have to pay a fine, the amount of which is fixed according to your personal situation.

The system is therefore predominantly based on prevention, allowing Americans to seek treatment earlier and avoiding, as was the case, too often in emergencies. Approximately 50 million Americans are targeted.

Federal reform, Obamacare has 10 essential points that must be included in each insurance. These include emergency care, hospitalization, maternity care, pediatric care, dental care (2x per year) and ophthalmos (1 consultation and 1 pair of glasses per year) for children under 19 years of age .

More information on the U.S. website. Department of Health & Human Services.

For the quenottes

Having a beautiful smile is expensive in America, because true dental insurance does not exist. At best, you can subscribe to a DISCOUNT PLAN, for about $ 200 per year, in order to benefit from reductions of 20% to 35% on dental procedures. Be sure to visit

DentalPlans.com, which gives a panel of all Dental Discounts and allows online subscription, in just a few clicks.

Good to know: Ask your dentist to claim a simulation of the cost to your insurance. It takes a few days, but you will know exactly how much you will have to shell out. Certainly the insurance reimburses a certain percentage of the bill, but it also has an annual coverage limit. Anything beyond is therefore for your pocket. 

Therefore, it is sometimes interesting to carry out a devitalization in December ... and a crown in January!


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