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The healthcare system in the United States is complex and differs a lot from the systems of other countries. The American model is based mainly on private insurance, complemented by government programs such as Medicare and Medicaid, which we will detail in this article.

Private health plans end up being the most used and are contracted by most Americans through employers, who often subsidize part of the costs.

Consulting a doctor or performing tests and procedures in the United States can be extremely expensive, making health insurance an indispensable necessity for most families.

In this article you will find detailed information on how the American health system works, including the types of insurance, essential terms such as co-participation and deductible, as well as tips for choosing the plan that best suits your needs.

health system in the US

Is there a public healthcare system in the US?

In the United States there is no universal public health system. Access to health in the US is largely based on private insurance and government programs that serve specific groups of the population. Although the country has programs that offer free or subsidized medical care, they are limited and do not serve the entire population.

How the Private Healthcare System in the USA works

The private health plan system in the United States is widely used by the population, being operated by insurers that offer different types of coverage. As mentioned at the beginning of the article, most Americans acquire their plans through employers, who often subsidize part of the costs. For those who do not receive this benefit, it is possible to contract plans individually through the private market or platforms such as the Health Insurance Marketplace, created by the Affordable Care Act (ACA), also popularly known as “Obamacare”.

Health plans vary in terms of cost, coverage and network of providers. They usually include monthly fees (premiums), deductibles – amounts that the insured must pay before the plan begins to cover the costs – and co-pays (co-pays) or co-insurance, which are additional amounts paid for specific services, such as consultations or exams.

Plans can be classified into different levels, such as HMO (Health Maintenance Organization), which requires patients to use a specific network of providers, or PPO (Preferred Provider Organization), which offers more flexibility to choose doctors outside the network, but at a higher cost. The choice of the ideal plan depends on factors such as medical needs, budget and location, and it is essential to carefully analyze the details before hiring.

Understand “Obamacare” and “Trumpcare”

Obamacare is considered a semi-public health system, created in 2010 by former President Barack Obama. Officially called the Affordable Care Act, the program aimed to expand the access of Americans and permanent residents to health plans, ensuring that more people have medical coverage. It was important because it brought rules that prohibited the refusal of coverage for people with pre-existing conditions and offered subsidies for families with incomes of up to four times the federal poverty line (Federal Poverty Level – FPL).

One of the most controversial measures of the program was the obligation (individual mandate) for everyone to have health insurance, under penalty of a fine for those who did not join. With the mandate and inclusion of previously excluded people (such as those with pre-existing conditions), insurers began to serve a greater number of patients, many of them with high medical costs. To cover these expenses, insurers increased the premiums (monthly fees) of the plans for those who did not receive subsidies, making private agreements more expensive for a large part of the population. Because of this, Obamacare was much criticized.

In 2017, during the Donald Trump administration, the obligation to have health insurance was revoked, along with the fine for those who did not join. In addition, other adjustments were implemented in the program, which became known as Trumpcare, marking significant changes in various aspects of the system established by Obamacare.

What are the Public Health Programs in the USA?

The public health system in the U.S. is a combination of public and private programs, and access to medical care often depends on factors such as age, income, and health status. Here are the main public programs:

Medicare.

  • Aimed at people aged 65 or older, in addition to some people with disabilities or specific conditions, such as chronic renal failure.
  • Funded by the federal government.
  • It offers coverage for hospitalization (Part A), medical services (Part B) and, optionally, medications (Part D).

Medicaid.

  • Intended for low-income people, including families, pregnant women, the elderly and individuals with disabilities.
  • It is administered by the states, but jointly financed by the federal and state governments.
  • Eligibility and benefits vary from state to state.

Children’s Health Insurance Program (CHIP)

  • It offers coverage for children in families who have too high income to qualify for Medicaid, but who cannot afford private health insurance.
  • It is also administered by the federal and state-funded states.

Veterans Health Administration (VA)

  • Provides health care for eligible military veterans.
  • It includes hospitals, clinics and other medical facilities administered by the federal government.

Indian Health Service (IHS)

  • It offers medical assistance to members of indigenous tribes recognized by the federal government.

Costs and Accessibility

The cost of health in the US is notoriously high, with medical expenses being one of the main causes of personal bankruptcy in the country. Medical appointments, exams and hospitalizations can cost thousands of dollars without proper insurance. Even with insurance, patients often face additional costs, such as annual deductibles and co-pays.

Although the quality of medical services is high, with access to advanced technologies and renowned experts, accessibility can be a challenge. Many plans have limited networks of providers and hospitals, which means that the patient may not be reimbursed if they seek care outside the network.

Considerations for Expatriates

For those who plan to live in the US, it is essential to take out health insurance even before the move. There are specific options for immigrants, such as temporary insurance, until a more comprehensive plan is established. Choosing the right plan requires attention to coverage, costs and the available service network.

Do you want to live in Florida?

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