An understanding of health insurance in the United States is essential for new permanent and temporary visa holders since the vast majority of healthcare provided in the US is private.

While the US spends around 17% of the national GDP on healthcare, much more than many other developed countries, the key indicators on health – life expectancy and infant mortality – show that the United States’ healthcare system performs much more poorly than many of those other nations which has an impact on the quality of life.

Few in the USA below the age of 65 are covered by the publicly funded health insurance schemes and so most people’s healthcare is funded by personal insurance schemes or schemes provided by their employers.

Public health insurance

The two main public health programs in the US are Medicare and Medicaid. The former guarantees access to health insurance for people over the age of 65 who have been legal residents of the US for at least 5 years. The latter is a program which supports low income families and individuals.

Since most people able to obtain United States visas are ineligible for the above schemes, we’ll concentrate on private health insurance.

Affordable Care Act

While there has been a lot of press over the less than effectual rollout of this law in the US, the act was put into place to try and sort of the mess that is the US healthcare system. Some of the changes that come under the Affordable Care Act are:

  • pre-existing conditions exclusions no longer apply to children under 19 years old.
  • young adults may be eligible to stay on their parent’s health insuranceup until 26 years of age.
  • insurance companies must publicly justify insurance rate hikes.
  • patients can seek emergent care in any hospital, including those outside of one’s healthcare network.

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While the healthcare system in America is not at the level it should be, it is slowly getting there. To find out more about the Affordable Care Act and to register, visit healthcare.gov.

Private health insurance

The United States government does not compel anyone to purchase even basic health insurance leaving healthcare squarely as the responsibility of the individual. While this takes some pressure off the new arrival it also exposes anyone without cover to the risk of running up huge medical bills.

Only emergency treatment is given to those without insurance and some hospitals and clinics will turn patients away with evidence of insurance or a deposit.

It’s therefore highly recommended that you arrange medical cover before, or very shortly after, you arrive.

There’s a whole plethora of medical insurance companies to choose from. You may be able to arrange cover from an insurer in your own country before you leave – many UK companies will insure you for US healthcare – but after one year you’ll normally have to find a US provider.

Top US health insurance companies

The five largest US health insurers, in order of market share, are: Unitedhealth Group; Wellpoint Inc. Group; Kaiser Foundation Group; Aetna Group; and Humana Group. Between them these five companies insure around half of the insured population of the US – more than 100 million people.

Health insurance costs

Private health insurance is expensive but when you consider that critical procedures and care can generate costs that run into the tens, if not hundreds of thousands, of dollars the expense is justified.

Healthcare through your employer

Most insurance coverage is employer-sponsored and most large employers provide group coverage which is usually more generous than Medicare. As such you may find that you have no need to arrange your own healthcare. However, your employer might ask for contributions towards the healthcare plan, i.e. a deduction from your stated salary.

You should examine your employer-sponsored policy carefully so you know exactly what you are and are not covered for.

Costs for private individuals vary based on age, occupation, lifestyle and pre-existing medical conditions.

The average cost to an employee enrolled in the company insurance plan is £932 GBP per annum for individual coverage while for family coverage that rises to £3,283 GBP per annum.

Paying for your health insurance in America

Dealing with averages, we find that the representative cost of healthcare in the US for an individual is £4,271 GBP per annum while family coverage costs £11,977 GBP per annum on average.

The most expensive states for health insurance are Alaska and Rhode Island, where average individual cover exceeds £4,564 GBP per annum; the cheapest are Georgia and North Dakota where it hovers at around £3,575 GBP per annum.