Healthcare system in the USA

If you are immigrating to the USA, you should not miss out on learning about the healthcare system because, in the land of freedom, you are generally responsible for your own health insurance coverage! This guide brings some light into the darkness of the complex health care system of the USA.

Structure of the US healthcare system

The US healthcare system is a mixture of some government programs and a variety of private providers.

When it comes to healthcare, however, there is little government interference in America. The insurance market is rather dominated by economic interests and competition. Each person is responsible for their own healthcare, and only certain groups of people are insured by the government programs Medicare, Medicaid, and Tricare.

Unlike in many other developed countries, there is generally no requirement to enroll in health insurance in the United States.

Government healthcare programs

There are a number of government programs in the USA that offer assistance in the event of illness – but only for certain groups of people.

Medicare benefits are available to any American age 65 or older, as well as people with a recognized disability or acute kidney failure.

The assistance program Medicaid is designed primarily for children and people with low incomes. To receive welfare-like Medicaid benefits, Americans must first have their eligibility assessed for need.

Another government health insurance program is Tricare, covering members of the military and their families.

Private health insurance

The majority of US citizens are covered by private insurance through their employer. In most cases, this is a group health insurance plan that is financed proportionally by the employer and the employee. Sometimes, the insurance is only offered by the employer and must be paid for entirely by the employee. The disadvantage: if the employee loses the job, there is a risk of losing the insurance coverage as well.

Those who can neither obtain insurance through their employer nor qualify for a government program must purchase private health insurance on their own. Since the 2010 healthcare reform known as "Obamacare" took effect, Americans have been able to find coverage that suits them directly through the US government's Marketplace.

Please note
Before purchasing a private insurance plan, you should carefully evaluate each offer. Many American healthcare plans do not cover dental treatment. Therefore, additional dental insurance is often indispensable.

Problems of the US healthcare system

The American healthcare system comes with a number of problems. In the USA, clinics and hospitals are generally modern and well-equipped, but quality comes at a price! In fact, there is no other country in the world where the cost of medical treatment and medication is as high as in the United States.

Hospitals are completely free to determine their own prices and therefore charge very high rates. Many hospitals justify their extremely expensive pricing by saying that they need to protect themselves against possible lawsuits for compensation.

The high cost of healthcare makes for high insurance prices and a very diverse range of services offered by the various providers. American health insurance plans often do not cover all medical treatments, so that many US citizens are not sufficiently insured. There are even about 29 million Americans who have no health insurance at all.

When people with insufficient or no health insurance come to a hospital due to an emergency, doctors are required by law to treat them. However, the high costs must be paid by the patients themselves. Thus, medical treatments that cannot be paid for are the most common reason for private insolvencies in the USA: about 650,000 Americans meet this fate every year.

Doctor's appointment in the USA

A doctor's appointment in the USA can be quite different from visiting a doctor in Europe. Here's what you need to know about doctors, medications, and emergency situations in the United States:

Visiting a doctor

In the USA, it is common for physicians to work with their colleagues in a group practice. This offers patients the advantage of having different specialists in one place. Often, doctors' offices are open even on Saturdays.

Besides the doctors, there are also "nurse practitioners" in many clinics. These nurses have studied at college and provide their own consultations. They usually take over basic tasks such as collecting data, measuring blood pressure, or giving injections before the doctor meets with the patient.

Visiting a dentist

Americans do not go for dental checkups but have their teeth thoroughly cleaned twice a year. Therefore, almost all American dental practices employ dental hygienists who are primarily responsible for cleaning teeth.

Besides cleaning, they also take a close look at all the teeth. Only if a health problem is identified in the process are patients sent to the dentist. For children, there are specialists in children's dentistry.

Medical emergencies

In the event of a medical emergency, you should dial the emergency number 911 as soon as you can or – if possible – drive to the nearest emergency room in the hospital. Unlike many European countries, ambulances in the US are not manned with an emergency physician but only with paramedics.

Paramedics undergo extensive training, which includes many procedures that are commonly performed by physicians in Europe (e.g., chest drainage, rapid sequence induction). However, their primary role is to get patients to the hospital as quickly as possible for medical treatment. Rescue helicopters in the United States also do not carry a doctor but are staffed by paramedics and flight nurses.

The emergency number should generally only be used in critical situations. Of course, it is also available to you if you are only visiting the States. But do not forget that all costs must be paid on-site. It is therefore highly recommended that you purchase travel health insurance for the USA in advance, which will cover the majority of the costs in the event of an emergency.

ESTA – visa-free to the USA

With an ESTA, you can stay 90 days visa-free in the USA. Apply online now!

Pharmacies & Medication

If you get a prescription for a medication, you usually go to a pharmacy with it. You can recognize American pharmacies by the Rx symbol. In large metropolitan areas, they are often located in supermarkets, which are sometimes open around the clock.

Before collecting a prescription, you should ask whether the pharmacy also works with your insurance company. Moreover, many health insurance companies also offer the service of delivering medications to your home (mail-order pharmacy). This can be even cheaper under certain circumstances.

Pharmacies in the USA not only dispense medications but often perform basic health assessments as well. In fact, pharmacists are considered the most accessible health care provider because anyone can visit them directly. You can also get vaccinated at many pharmacies, for example, against the flu.

More USA facts

Do you want to learn more about life in the United States? We've got you covered: take a look at our articles on driving, the school system, naturalization, and the tax system in the USA.