When most people think about healthcare in the USA, one word springs to mind -money.
Compared to the NHS back home, getting sick in the USA can cost you an arm and a leg. However, in the words of my cousin Christine - medical treatment over here is “the best in the world and you don’t have to wait”.
Christine, a former NHS nurse from Durham, shared her opinion with me when I first moved across the pond.
At the time of our conversation, she was living in Canada (with a public healthcare system like the UK) and had been waiting two years for knee surgery. She was eager to move back to the States again, namely, to get her op done quickly.
So aside from minimal wait times, here’s what you need to know about medical care as an expat in the USA…
General
How does the US healthcare system work?
Unlike the UK, America doesn’t have a nationalized health system funded by the taxpayer, offering universal coverage to all.
Here, most healthcare is private, and most people have to pay for health insurance. There is a huge emphasis on regular check-ups, prevention and routine screening.
Insurance companies often sponsor local fun-runs as well as offering discounts on exercise equipment and gym membership. Annual physical exams, comprehensive blood tests and cancer checks are highly encouraged, and entirely paid for by most insurers.
The hope is, that by discovering any serious issues early on, intensive (and expensive) treatment can be avoided later.
What are healthcare facilities like in the USA?
You’ll see private medical facilities absolutely everywhere - from drive-thru pharmacies to holistic practitioner offices, physiotherapy clinics and specialist medical centers of every kind.
There are also plenty of walk-in “doc in a box” options, like the shiny new clinics by Walmart superstores that provide GP, dental, hearing and optician services and X-ray facilities all under one roof.
You can even book a virtual video chat with a doctor from the convenience of your home or office.
Most towns have numerous hospitals with private rooms, state of the art equipment, and no waiting lists or budget restrictions.
Nothing is too expensive when your insurance company foots the bill. When our dear friend Jim suffered a heart attack, a helicopter was dispatched to airlift him to hospital. The total amount would have been enough to give anyone another heart attack. Luckily Jim had insurance and the company picked up the tab.
As an expat am I entitled to healthcare in the USA?
Yes. Provided you have insurance or can pay for it yourself. Everyone living in the US can get healthcare regardless of their immigration status.
Do GPs exist in the USA?
Yes. While known as family doctors here, you’ll find you can always get an appointment when you need it and will often receive routine test results by phone the next day.
How is the USA tackling the COVID-19 pandemic?
To date, over 168 million people have been fully vaccinated in the United States, and about 70% of the population have received at least one shot in the arm. With Covid cases rising, many parts of America are now returning to mask mandates again with $100 incentives offered in some states to encourage those who are reluctant to get the jab.
Luckily, under the Covid CARES Act of 2020, Coronavirus testing, treatment and vaccination are all covered 100% by insurance companies and the US Department of Health. Even if you are uninsured, you won’t pay a penny towards pandemic-related costs.
Costs
How much does USA healthcare cost?
Medical bills in the United States are the highest in the world.
A visit to the family doctor costs on average $90 if you are insured, or $230 (£166) without insurance. A hospital stay can set you back about $5,000 a day. The price of one cancer drug (Avastin) alone is nearly $4,000.
Unlike countries such as the UK, most health costs here are not government subsidized, so you can expect charges to be significantly higher.
How much does an operation cost in the USA?
The simple answer - a lot! Common operations such as a knee replacement costs about $35,000, while heart bypass surgery is around $80,000. Other major treatments can cost several hundred thousand dollars - more info here.
Health Insurance
How does health insurance work in the USA?
Most Americans and expats pay a monthly (or fortnightly) premium for health insurance – and the costs don't stop there.
Insurance companies work with their own network of doctors and hospitals. If you have what’s called a HMO plan, you can only use the providers approved as “in network”, or risk ending up paying the full bill yourself.
Some insurance companies are more flexible. If you have a more expensive PPO plan, they'll allow you to be treated outside their network, but usually at a reduced reimbursem*nt rate.
Even if you manage to stay “in network”, different plans offer different levels of coverage - which means you may still end up paying towards some services from your own pocket. Even a GP visit may involve an extra fee or “copayment” and “deductible”.
Copay vs deductible health insurance – what’s the difference?
Your copay is the contribution you make towards each of your claims. It’s usually a relatively small amount, such as $25 to see your doc or $100 for a consultation with a specialist. Your insurance then pays the rest of the bill, but only if you’ve already reached your deductible.
Your deductible is a bit like an excess back home in Britain - a set amount you have to pay each year before your health insurance kicks in. Your deductible could be $0 or a few thousand dollars, depending on your plan.
Fortunately, the total amount of all your copays and deductible is capped annually (this is called your “out-of-pocket maximum”). Once you’ve paid this (typically around $4,000), your insurer covers everything else 100% till the end of the year.
Should I get health insurance in the USA?
Yes! Given that health insurance is expensive and a huge hassle, you might be tempted to skip it altogether. However, the cost of medical treatment here can be astronomical, so you should get insurance.
How do I get health insurance in the USA?
Most people in the US get health coverage through their employer, and this is a major perk of going to work.
Forget Christmas bonuses, free lunch, or the odd office party - many Americans apply for jobs based purely on which insurance package is offered.
Luckily, we have always had good coverage from our schools through private providers and have never been uninsured since we moved stateside. Our plan includes everything from GP appointments specialists, hospital treatment, to dentist and optician services.
However, this perk is still not free. Employers heavily subsidise the cost for employees and their families, but you usually still pay a (reduced) premium for your policy each month.
How much are health insurance premiums on average?
In 2020, the average health insurance premium was $456 for an individual and $1,152 for a family per month. However, the cost varies widely depending on the plan you get.
Health Statistics
How much does the USA spend on healthcare?
More than any other country in the world. The most recent (pre-pandemic) data shows that $3.8 trillion was spent on healthcare in America - about $11,582 per person per year. This amount is growing rapidly - it is already expected to be $6.2 trillion by 2028 without even considering the huge impact and knock-on effect of the COVID-19 pandemic.
What is the life expectancy in the USA?
According to statistics published by the CDC (Center for Disease Control) in 2020, life expectancy for the total US population was 77.8 years (75.1 for men and 80.5 for women). This is a drop from previous years, mainly due to pandemic-related factors.
How healthy is the USA compared to other countries?
Americans are usually the first to gain access to new major medical advances, often discovered at American universities and developed by American companies.
However, on average, Americans live shorter lives and experience more injuries and illnesses than people in other wealthy parts of the world. Reasons for this include higher rates of poverty and unemployment, and a lack of health insurance in a country with a private healthcare system.
If you’re uninsured, you’re more likely to delay or avoid expensive medical treatment.
Do all Americans have health insurance?
No, and many of the 31 million uninsured Americans face serious debt and even bankruptcy due to medical bills.
Other FAQs
What is Obamacare?
During his presidency, Barack Obama introduced healthcare reforms under the Affordable Care Act, which was nicknamed “Obamacare”.
This guaranteed minimum essential healthcare by creating an online marketplace selling government-approved insurance and extended federally-funded cover for the most vulnerable Americans.
The controversial part of Obamacare was the mandate for everyone in the US, including expats, to take out health insurance or be faced with a fine. This law was later revoked but left each state able to make their own decision, so depending on where you live, you could still be fined for being uninsured (in California, for example).
What is the ACA Marketplace?
If you’re not insured through an employer and you don’t qualify for Medicare or Medicaid, you can go shopping at the online Marketplace established by President Obama.
The cost of these private policies vary greatly by state, with Vermont having the highest average monthly premium last year of $1,034, and Massachusetts having the lowest average at $398 a month. If you’re on a low-income in Mississippi for example, you’d pay the reduced rate of $49 a month for a Marketplace insurance plan.
What is Medicaid and Medicare?
With private health insurance dominating America, only a few groups of people qualify for care through two government programs. Those who are disabled and anyone over 65 pays around $200 a month for Medicare, while Medicaid provides means-tested free and reduced-cost cover for those on very low income, including the unemployed.
The Bottom line
Going back to my cousin Christine, I’ve never forgotten her words. Although I’m still staggered at the megabuck’s medical costs in the US, I’m grateful to get the very best care as soon as I need it. I’m truly fortunate to have insurance – even if I sometimes begrudge paying the premiums, copays, and deductibles.
I never struggle to get a GP appointment and rest easy knowing I won’t be placed on a two-year waiting list for surgery. As an expat in America, in sickness and in health, you get what you pay for.
