Medical insurance

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Medical insurance

1. Matters needing attention

In the United States, medical treatment is very expensive. Chinese embassies and consulates in the United States cannot pay or provide medical assistance for you. It is best for those who go to the United States to purchase comprehensive travel and medical insurance in advance before going abroad, pay attention to different concepts such as accident insurance, medical insurance, and special insurance, and understand the claims process in detail. Medical consultation is required before travel to ensure that you have the latest vaccinations.

It should be noted that wild animals including bats may transmit plague and rabies. Other infectious diseases include Rocky Mountain spotted fever, hare disease, arthropod-derived encephalitis, seasonal influenza, hepatitis A, etc. . Rodent-derived hantaviruses have been shown to exist primarily in the western United States. Lyme disease is endemic in the northeastern and mid-Atlantic regions of the United States and has also appeared in western regions such as California in recent years. Recently, West Nile virus cases have occurred in the New York area. In 2016, more than 1,000 cases of Zika virus (ZAKA) originating in Central and South America were found in southern America such as Texas and Florida. The United States announced the elimination of measles in 2000, but the number of cases has rebounded strongly in recent years. From January 1 to July 18, 2019, a total of 11,400 measles cases were diagnosed. There are about 10,000 cases of valley fever in the United States each year, mostly in the southwestern United States (Arizona, California, Nevada, New Mexico, Texas, and Utah), most of which are in Arizona and California. In recent years, the incidence of foodborne diseases such as enterohemorrhagic E. coli and salmonellosis has increased in some regions. Other diseases include being bitten by poisonous snakes and being stabbed by poison ivy. In northern regions, low winter temperatures can cause frostbite.

2. Medical overview

The overall level of medical conditions in the United States is relatively high and the facilities are complete. The institutions that provide medical care mainly include hospitals, doctor clinics, nursing homes, rehabilitation centers, independent diagnosis and treatment centers, and independent pharmacies. Large hospitals are equipped with advanced medical testing equipment and operating rooms, mainly providing medical services for emergency patients and patients with serious problems. Ordinary patients usually go to a doctor’s office in the community. Community doctor clinics have the characteristics of small scale, large number, wide distribution, and convenient medical treatment. They usually provide basic medical services such as general physical examination, disease course follow-up, family health care, general internal medicine, pediatrics, obstetrics and gynecology, orthopedic surgery, and ophthalmology.

Drugs in the United States are divided into prescription drugs and non-prescription drugs. The purchase of “prescription drugs” must be based on a “prescription” issued by a doctor, and “prescription drugs” must be sold by a licensed pharmacist working in the “pharmacy”. Some supermarkets and discount stores also have pharmacies where you can buy non-prescription medicines without a doctor’s prescription, such as aspirin or common cold medicine. In general, commonly used medicines are available locally.

Medical insurance institutions have great restrictions on hospitals. Due to the high cost of hospitalization, to control medical expenses, insurance companies try to reduce the number of days of hospitalization for patients, requiring patients to be hospitalized in an acute hospital (Acute Hospital or Short-term Hospital) for 5-7 days (entering the recovery period), that is, to transfer to a relatively low-cost hospital. Nursing homes (SNFs, Skilled Nursing Facilities) or family care centers (Family Care Center), or directly to the community doctor’s clinic for follow-up. In emergencies, we usually choose to go to the Emergency Center for medical treatment.

3. Medical Insurance

The American medical insurance system consists of social medical insurance and private medical insurance. Due to the high cost of seeing a doctor in the United States, if you do not purchase insurance, it will be difficult for individuals to bear huge medical expenses, so many people participate in social medical insurance and private medical insurance at the same time.

(1) Social medical insurance

Offered by the US Department of Health and Human Services for US citizens and permanent residents. There are mainly the following two categories:

1. Medicare, which provides medical insurance for the elderly over the age of 65, is the second-largest government financial expenditure project after social security projects. The health insurance program is administered by the federal government, and policies are unified among states. Medicare covers approximately 90% of the medical bills for hospitalization for the elderly. Government health insurance includes two parts, A and B. Part A is inpatient medical insurance (HI). Part A is compulsory, which allows participants to enjoy 90 days of hospitalization and 100 days of skilled nursing care each year. If both occur in the same year, the patient incurs a small fee. Part B is Supplemental Medical Insurance; “Supplementary Medical Insurance” (SMI), which is used to pay for out-of-hospital doctor’s consultations, doctor-designated drugs, and other out-of-hospital medical services. Unlike mandatory hospital medical insurance, supplemental medical insurance is voluntary. Those enrolled in supplemental health insurance pay a monthly premium, currently $40 per person per month. Nearly all (99%) seniors are enrolled in supplemental health insurance.

2. Medicaid, which provides health insurance to low-income Americans. Government medical insurance is the largest insurance that provides medical and health services for the poor. Under the guidance of the federal government, each state sets its eligibility criteria, insurance level, content, etc., so the content of state government medical insurance varies.

(2) Private medical insurance

Commercial medical insurance companies are mostly undertaken by private individuals, and their various plans make up for the restrictions imposed by government medical insurance plans on people’s enjoyment of medical services and meet the needs of different levels of people. Commercial health insurance companies pay 37% of total medical expenses. Private health insurance is often used as a non-wage benefit. Employer-Provided Insurance is paid by employers for employees, and some people purchase private health insurance on their own.

(3) Health insurance for international students in the United States

Many educational institutions have mandatory regulations that foreign students must purchase health insurance, to ensure that these students will not become “supporters of government relief”. Although F-1 and M-1 nonimmigrant visa holders are not required to buy health insurance, the US State Department stipulates that the coverage of exchange visitors on J-1 visas must include illness and personal accidents.

Health insurance plans specifically for foreign students: The National Association for Foreign Student Affairs (NAFSA) and the Association of International Education, together with four insurance companies, To meet the needs of international students, an insurance policy (insurance policy) has been developed, which covers a wide range and is reasonably priced.

The basics covered by health insurance include doctor’s treatment (or a percentage) for major illnesses, hospitalization, and surgery. Minor illnesses and minor illnesses and injuries are treated in a doctor’s treatment room, and most insurance plans do not cover the cost of such common treatment. If your spouse or dependents also come to the US, make sure you find out if she (or him) is covered by your health insurance. Dependents’ health care can be covered by purchasing a “Family Plan”, which covers both the self and the dependents.

The main ones not covered by the basic health insurance plan are:

1. Maternity care and treatment: Insurance for maternity care needs to be purchased separately and generally must be purchased before pregnancy. Most maternity plans only cover hospital bills for two days.

2. Dental Treatment: If your teeth need treatment, it is best to do so before coming to the United States.

3. Ophthalmology: If you wear glasses, go for optometry before departure, and carry a spare pair of glasses and your optometry prescription (in English). Eye disease is generally not covered unless your eye is traumatized.

Pre-existing conditions: Most insurance companies are not responsible for paying for treatment of pre-existing conditions before you purchased the policy.