Deciphering The US Health Insurance System

Individuals moving from Canada to the United States have a lot to figure out before they leave, including how to obtain a visa, how to transport their belongings and where to live. One of the most baffling aspects of moving to the U.S., however, is deciphering its health insurance laws, especially after the passing of the Affordable Care Act in 2010. 

The following are some of the most important questions about health insurance Canadians, or international movers, moving to the U.S. need answered before they arrive.

Do I need health insurance?

According to the individual mandate, all individuals in the U.S. need health insurance, or they will pay a penalty come tax time. Even if the mandate wasn't in place, however, it is a good idea to have health insurance in the U.S., as health care costs there are quite high, and only individuals facing economic hardship qualify for public programs.

Where can I obtain health insurance?

There are three main sources of health insurance in the U.S.: employers, the government and the health insurance marketplace.

  1. Employers. Many employers, especially larger companies, provide their employees with health insurance paid for with a deduction from the employee's paycheck.
  2. The government. The government generally supplies health insurance only to those facing economic hardship and senior citizens. It does so mainly through two programs--Medicare (not to be confused with Canadian Medicare) for the elderly and Medicaid for families with low incomes.
  3. The health insurance marketplace. Insurance can also be purchased by individuals directly from private insurance companies. Since the passing of the Affordable Care Act, this can be done most easily through your state's health insurance marketplace, which can be found at Healthcare.gov.

What are the different types of health insurance?

There are three main types of health insurance plans: HMOs, PPOs and POS plans.

HMOs, or Health Maintenance Organizations, are health insurance plans under which health insurers have a contract with doctors, hospitals and other health care providers. Individuals who visit these providers pay a fee, or copay, for each visit, procedure and medication. If the provider is outside the insurer's network, the individual generally pays more. Patients generally need a referral from their primary care physician in order to see a specialist.

PPOs, or Preferred Provider Organizations, work in a similar fashion, though patients generally do not need a referral in order to see a specialist.

POS, or Point-of-Service plans, combine features of HMOs and PPOs and serve as a middle ground in terms of cost and flexibility.

How does the Affordable Care Act affect me?

First, the Affordable Care Act requires that all individuals in the U.S. have a health insurance policy.

The ACA also has some benefits for patients. One benefit deals with individuals with pre-existing conditions, or health conditions that the individual contracted before he or she bought the insurance plan. In the past, insurance companies could deny or restrict coverage for such individuals; however, this is no longer the case. 

In addition to Medicare and Medicaid, the ACA now gives the government the authority to issue subsidies to assist with health insurance premiums for low-income families, or families earning between 100 and 400 percent of the poverty line.

Are there waiting lists for doctors' appointments and procedures in the U.S.?

Generally, there are not. Some popular doctors have busy schedules, but health care waiting periods are not a key issue in the U.S.

As a Canadian, you may find the U.S. health care system confusing. With so many different kinds of insurance, the process can appear complicated. That's why it is important to research any issues you may have before arriving to the U.S. Add "get health insurance" to your moving checklist today.


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