Nobody can deny that understanding how health insurance works in the USA is not the easiest job. However, it’s something that you need to know if you are already a citizen of the US or you’re planning to move here.
The first thing you need to know is that health insurance is not obligatory. You can choose not to get it, but then it’s easy to lose all your savings due to an unexpected hospital bill which can reach even up to $300.000.
If you decide to get it, at the end of each year, you will get the 1095 form, which is basically proof of you being insured. It is useful as documentation if you want to claim any extra deductions on your taxes.
Below, you’ll find a list of insurance programs that are available in the US. Hopefully, this will help you in choosing the option for you. So without further ado, let’s begin.
Medicare
Who is it for? If you are over 65, you probably qualify for the Medicare program. Apart from seniors, it also provides healthcare for younger people with specific disabilities, as well as those who suffer from End-Stage Renal Disease. T
o qualify for the program, you need to be either a US citizen or a permanent legal resident for the last five years. Those who receive Social Security disability insurance usually need to wait, two years before they become eligible for it. However, people with permanent kidney failure or ALS might become eligible immediately.
What does it cover? When it comes to what this program covers, everything depends on which plan you choose (A, B, C or D). People usually enroll into plan A and B.
- Plan A covers things like your stay in the hospital and hospital services. It also includes the costs of hospice care, wheelchairs, walkers, stays in nursing facilities, blood if you need a transfusion, home healthcare services, and hospital inpatient costs.
- Plan B covers preventive healthcare and doctor services. This includes a wide range of tests, such as screening for cancer or diabetes.
- Plan C gives you more coverage for an additional cost. With this plan, you get, for example, drug prescription coverage or dental coverage. To enroll into plan C, you need to be enrolled in plan A and B.
- Plan D covers prescription drugs that plan B does not cover.
Medicaid
Who is it for? Medicaid mainly provides healthcare for people from low-income households (mostly children). Still, not only – other requirements might decide if you qualify or not, which are related to age, pregnancy status, citizenship, etc. People who are receiving SSI (Supplemental Security Income) are also eligible for the program.
What does it cover? Medicaid covers things like inpatient and outpatient hospital expenses, home health care, nursing home care and doctor visits. In contrary to Medicare, Medicaid covers the costs of long-term care, both at home and in a nursing home.
Children’s Health Insurance
Who is it for? CHIP is an insurance program for children in families that earn too much money to qualify for Medicaid but can’t afford private health insurance. In some of the states, CHIP also covers pregnant women. Every state has its own rules to determine who qualifies for the program.
What does it cover? CHIP covers things like doctor visits, prescriptions, dental and vision care, emergency services, x-ray services, immunizations, routine check-ups, etc. Each state can provide more benefits, but the ones listed are the ones offered by every state.
Tricare
Who is it for? Tricare provides healthcare to uniformed service members, retirees and their families from all over the world (including former spouses). You need to be listed as eligible for military health care benefits in DEERS.
What does it cover? Tricare covers all of the medical services that are necessary (appropriate for your condition and considered proven). Some time ago, it also started to include the medically needed foods and vitamins.
Indian Health Service
Who is it for? The Indian Health Service provides healthcare to federally recognized American Indians and Alaska Natives in the USA. A lot of things can determine if you are eligible for the program, such as, for example, membership in a tribe (with active participation in the tribal affairs). You might also qualify if you are connected to an eligible Indian by, for example, being married to them or being pregnant with their child.
What does it cover? Indian Health Service covers a variety of services in both inpatient and outpatient settings. The benefits include dental, health, immunizations, pediatrics, physical rehabilitation, and optometry.
