Sick and Confused? The Basics of the US Medical System
Some aspects of moving to a new country are easier to understand than others. While you may be able to understand the subway system and how to find some of your favorite foods from back home, other aspects don't rely on intuition. One area of living that is different in almost every country is healthcare and what to do when you are feeling ill or in a health emergency. With a healthcare system that is renowned for being expensive and potentially unfair, understanding who to see and when to see them is critical to both staying in good health and controlling your healthcare costs.
Let's Talk Healthcare
If you are coming from a country that has national or socialized healthcare, adjusting to the system that is currently in place in the United States is certain to be an eye opener. Many Europeans will be surprised that healthcare costs are not tax deductible unless they exceed 7.5% of your total income and you choose to itemize those expenses on your taxes.Healthcare is primarily private in the United States, meaning that a monthly out-of-pocket expense should be expected. Many employers will offer benefit packages that include a portion of their employees’ healthcare being covered at the employer’s expense, but you should still expect to pay a contribution out of your paycheck. If your employer is not offering healthcare, you will want to consider your options.Many Americans, especially those with lower incomes, choose to live without healthcare due to the high cost. While this can lead to high medical bills that must be paid out of pocket, the reality of the situation is that many people simply cannot afford it.There are government systems in place to take care of those who are in need and the elderly. Medicaid is the system in place to take care of low-income families and those who cannot afford the medical attention they need. Medicare is the system that is used to take care of the elderly or individuals who are deemed to be disabled. Both of these systems will cover a number of expenses, but there is a limit to what the government will cover. For that reason, many Americans choose private medical insurance.There are a number of private providers that offer healthcare plans, all with different rates and deductibles.
Deductibles?
Paying deductibles is a concept that is foreign to a number of international citizens when they first arrive in the United States. A deductible is an amount of money which a person must pay toward their medical expenses before the insurance company will pay the remainder. Deductibles are payments that are in place to stop people from “abusing” the insurance companies and going to the doctor's office too frequently. These payments are typically low, but do vary based on the type of doctor you are going to see and your healthcare plan. Plans with a higher monthly payment usually offer reduced deductibles. For example, a plan that costs you $150 a month might have a deductible of $1000 on an emergency room visit compared to a plan with a monthly payment of $400 that would have a $50 deductible for the same visit.Your deductible payments will depend on your insurance company, the policy you have taken out with the insurance company, and the type of doctors or medication you are expecting to need. Deductibles should be expected for doctor visits, prescriptions, and any emergency operations or expenses that would arise.
Feeling Ill?
An important part of picking your healthcare plan and understanding your deductibles is knowing what type of doctors you will need to see and when it is appropriate to go to the emergency room. While it is not uncommon in other countries to go to the hospital when you are feeling ill, visits to hospitals in the United States are incredibly expensive and generally should be reserved for emergencies.It may be surprising to some internationals that many Americans will first try to self-medicate or self-remedy their ailments before seeking medical attention. A sore throat, irritated skin or moderate fever would call for a trip to the pharmacy to see if cold medicine, creams or pain killers could alleviate these symptoms.If Americans can't fix the problem themselves, they then visit their primary care physician (PCP) or general practitioner (GP). This is a doctor who would be your first stop when you are ill and would be the same doctor you would see for your regular health checkups. The doctor will then give you a course of action which can include assigning prescriptions, recommending that you see a specialist for specific needs, or sending you to the hospital for emergency attention.
Specialists
Specialists are doctors who focus on specific medical issues. Specialists are available for a number of issues and may be required for certain symptoms. For example, if you are having skin irritation or bad acne, your PCP will refer you to a skin doctor (dermatologist) who would be able to better take care of your needs and prescribe you the medicine that you will need.Most health insurance companies will require that you see your PCP first and get a referral for a specialist before they approve the specialist visit. If you go to a specialist on your own without a referral from your general practitioner, the visit will most likely not be covered (or less of the cost will be covered) and you will see a large out-of-pocket expense. Note that this may still happen if the specialist your doctor recommends does not accept your insurance. Before scheduling an appointment with a specialist you will need to check that your insurance is accepted.Some specialists that are required by everyone, such as dentists and eye doctors, will not require a referral but often times require separate insurance plans.
Medicine and Prescriptions
If you are an Asian international, you may find that some of the drugs you are used to buying over the counter at a pharmacy are not available. On the contrary, European internationals may find the availability of certain drugs over the counter a bit surprising.
Emergencies
Accidents happen no matter where you are living - and this is one of the times when a hospital trip may be the first course of action. Ailments such as extremely high fever (more than 103 degrees Fahrenheit or 39.4 Celsius), seizures, loss of consciousness, or broken bones would warrant a trip to the emergency room. It is important to note that ambulance services are not free and each insurance company has their own policy regarding ambulance trips to the hospital - some will only cover the cost if the situation required the patient to be adm
itted to the hospital. In any case it's better to be safe than sorry, so don't risk your health, or the health of others on the road by driving yourself to the hospital simply to save money.When you get to the emergency room, you should expect to fill out a collection of paperwork as hospitals are required to document the patient, the cause of your illness or injury, and the insurance you may or may not have. You will also be required to give an accident report stating exactly what happened and explain what the patient, be it yourself or others, is experiencing. Even without insurance, hospitals are required to treat you and will happily do so.Emergency Rooms generally also will require a bit of a wait. More severe traumas, such as individuals coming from car accidents or having heart attacks, will be taken before individuals with broken arms or cuts that would require stitches. You need to be patient in hospitals as they are doing their best to deal with the number of patients they are receiving, the different conditions of each patient, and complying with the rules and regulations of the hospitals and insurance companies.
Healthcare Reform
While the Obama administration has taken strides to push towards a more fair healthcare system, it cannot change overnight. President Obama has now made it illegal to refuse health insurance for individuals with pre-existing conditions and is pushing for more government influence on the healthcare system. He also has allowed young people (under 26) to remain on their parents’ health plans until they have benefits from their employers.
What do I do?
Choosing how you will be sure that your health expenses are covered is a critical decision as you set up your life in New York City and the United States of America. Be sure to read all the fine print from any medical insurance provider, be it private or one of the options from the government, before you choose it as your primary insurance. If you have any questions be sure to ask for advice from your friends, co-workers or other internationals who have made the move to the states to ensure you're making the right decision when it comes to your healthcare.Article updated December 2014