Healthcare in the United States
The US healthcare system is complex, expensive, and unlike any other developed country. Understanding it is crucial for financial survival.
How Health Insurance Works
Employer-Sponsored Insurance (ESI) covers about 155 million Americans and is usually the best option. Employers typically pay 70-80% of premiums.
Affordable Care Act (ACA) Marketplace offers plans during open enrollment (Nov-Dec) or after qualifying life events. Subsidies available based on income.
Medicare is for those 65+ or with certain disabilities.
Medicaid is for low-income individuals (varies by state).
Key Insurance Terms
| Term | Meaning |
|---|---|
| Premium | Monthly payment for coverage |
| Deductible | Amount you pay before insurance kicks in ($1,000-$6,000 typical) |
| Copay | Fixed amount per visit ($20-50 typical) |
| Coinsurance | Percentage you pay after deductible (20% typical) |
| Out-of-pocket max | Most you'll pay annually ($8,000-16,000 typical) |
Typical Costs Without Insurance
- ER visit: $2,000-5,000+
- Ambulance: $500-2,000
- MRI: $1,000-3,000
- Childbirth: $15,000-30,000
- Appendectomy: $15,000-40,000
For New Immigrants
- H1B/L1 holders: Employer must offer health insurance
- F1 students: School requires health insurance (often provides plan)
- Green card applicants: Must prove won't become public charge
- Visitors: Travel insurance strongly recommended
Finding Care
- Primary Care Physician (PCP): Your main doctor for general health
- Specialists: Often need PCP referral depending on plan type (HMO vs PPO)
- Urgent Care: For non-emergency issues outside doctor hours ($100-300)
- Emergency Room: Life-threatening emergencies only (very expensive)
Mental Health
Mental health coverage has improved under ACA parity rules, but finding in-network providers can be challenging. Many therapists don't accept insurance. Online therapy options like BetterHelp, Talkspace cost $60-100/week.
Pro Tips
- •Never go without health insurance - medical debt is devastating
- •Understand your deductible and out-of-pocket max before using care
- •Use in-network providers whenever possible to avoid surprise bills
- •HSA (Health Savings Account) if available offers triple tax advantages
- •Negotiate bills - hospitals often reduce charges significantly
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