How does healthcare work in the United States, and what travel insurance, health insurance or expat insurance do you need?

How does the health and healthcare system work in the United States?

• The state of medical care in the US is not very good and remains a current and ongoing problem. Although 15% of the GDP is spent on healthcare, 30 million Americans cannot afford the cost of medical care.
• Healthcare costs are some of the highest in the world. Even a simple doctor's appointment can cost hundreds of dollars without insurance.
• There is no universal healthcare system, only a system for people of a certain age and income. Care is provided through a combination of public and private providers.
• Insurance is essential and sometimes required as part of immigration or visa requirements.
• The United States is a very popular destination for foreign doctors for both internships and research.
• American doctors are known for using the latest, and abundant, medications and for conducting many medical studies. Most medications are available at pharmacies (such as Walgreens or CVS), but some medications require a doctor's prescription.
• If you are taking specific medications, bring enough with you or get a doctor's note to get them refilled.
• For emergency medical care, call 911.

How does the public healthcare system work in the US?

• In the United States, medical care must be paid for in advance and nothing is free. There is also a price tag for treatments in public hospitals. The patient or the insurance company must pay for the care, so they check to see if you have insurance.
• Medical care for the elderly is provided through a government program called Medicare. The unemployed can apply for Medicaid, provided by a combination of federal and state Medicare. About 15% of American citizens do not have health insurance and rely on Medicare or Medicaid and other charities.
• Although many Americans do not have private insurance to cover all aspects of care, much emergency care is provided free of charge by city and county schools that are supported by municipalities. There are continuing concerns in the medical community and government about how to provide healthcare to low-income patients.

How does the private healthcare system work in the United States?

• Three-quarters of U.S. hospitals are privately owned. Private healthcare is the norm in the U.S. and generally provides access to modern facilities and specialized care.
• Many Americans do not have private insurance to cover all aspects of healthcare.
• As an expat, it is important to have good insurance that covers the high costs of both private and private medical care. Many employers also offer health insurance as a fringe benefit.

How is the GP arranged in the US?

• In the United States, dentists and family doctors have their own practices. As a result, healthcare is expensive. A family doctor is called a Primary Care Physician (PCP).
• You usually choose a PCP through your insurer. This doctor acts as your first point of contact for non-urgent medical questions and refers you to specialists if necessary.
• A visit to a family doctor often costs $100-$300 without insurance.

How is the dentist arranged in the US?

• Dental costs are generally very high compared to other countries and are usually not included in standard health insurance plans. 
• Many large hospitals, especially those affiliated with universities, have dentists who treat at lower prices than dentists in a private clinic. 

How is the pregnancy care arranged in the United States? 

• Pregnancy and postpartum care in the United States is of high quality, but is also very expensive.
• Prenatal care is comprehensive and well organized. Pregnant women often see an OB-GYN (obstetrician-gynecologist), a specialist responsible for pregnancy care and childbirth.
• During pregnancy, you will have routine ultrasounds, blood tests, and other tests. Some women also choose a midwife or doula for a more natural and personalized approach.
• Please note that access to this care depends on your health insurance. The cost without insurance can quickly add up to tens of thousands of dollars. A natural birth can cost $5,000-$11,000, while a C-section can cost $15,000-$20,000 or more.
• Many employers offer maternity coverage through their health insurance, so if you are an expat working in the US, it is important to check if your insurance covers it.
• Most women give birth in hospitals, which are well equipped with modern technology. 
• Alternatives include birth centers or home births, usually with a registered midwife.
• Home births are legal, but less common than in some other countries such as the Netherlands. About 1% of births occur at home.
• Unlike some other countries, maternity care in the US is quite limited. After a vaginal birth, you usually go home within 24-48 hours. With a c-section, you often stay 3-4 days. There is little to no home care available, so many parents hire a doula or other helper.
• Breastfeeding in public is legal in all 50 states, but reactions to it can vary by region. In progressive cities such as New York and San Francisco, it is generally accepted, while in more conservative parts of the country it can sometimes lead to mixed reactions.
• Many mothers use a blanket or nursing cloth to keep breastfeeding more private, but this is not mandatory.
• Maternity leave is not regulated nationwide like it is in many other countries. It depends on your employer and insurance plan. Many mothers only have 6-12 weeks of unpaid leave under the Family and Medical Leave Act (FMLA).
• Some employers offer paid leave, but this is not necessarily the standard.

How safe or unsafe is it to travel or stay in the United States?

What should you pay attention to in terms of safely in the US?

• The US is generally safe for expats, but there are differences between states, cities, and even neighborhoods. Major cities like New York, Chicago, and Los Angeles have areas where tourists and expats may want to be more vigilant, especially at night.
• Gun violence is a major concern. Gun ownership in the US is high, and shootings are unfortunately more common than in many other countries. It is wise to be aware of the local situation and follow the advice of locals. Most expats live in safe areas. Shootings are particularly common in poorer neighborhoods.
• Violent crime is more common in certain urban areas, but most expats do not experience this directly. Make sure you are well-informed about safe neighborhoods. Petty crime, such as pickpocketing, is more common in busy tourist areas or during events. Keep an eye on your personal belongings.
• Be careful at demonstrations: Political rallies can get out of hand, especially during times of election or social unrest.
• Avoid unsafe neighborhoods and check with local sources for places to avoid.
• The US experiences a variety of natural disasters, including hurricanes (Southeast Coast), earthquakes (West Coast), tornadoes (Midwest), and wildfires (West). Make sure you are familiar with your region’s disaster plan.
• Some tips: be calm with police, always show your hands, and treat police with respect; be aware of scams, especially in tourist areas; stay in well-lit areas.

What should you look out for in terms of diseases in the US?

• There are no specific vaccinations required for the US. However, it is recommended that you keep your basic vaccinations, such as tetanus, measles, and hepatitis A, up to date.
• Tick bites can be a risk in rural areas and forested states. They can transmit diseases such as Lyme disease. Check yourself after hiking.
• The drinking water in most parts of the US is safe, especially in urban areas. Some expats prefer filtered water because of the chlorine taste. In rural areas, it is better to ask about the quality of the water.

What should you pay attention to when it comes to traffic in the US?

• The US is a car-oriented country, and in many areas a car is essential. Public transportation is limited outside of major cities.
• Roads are generally in good condition, but traffic laws and driving behavior can vary from state to state. Be careful when driving on highways; speeds are high, and trucks make up a large portion of the traffic.
• Road safety is fairly good, but fatalities are not uncommon. Especially in rural areas, driving after dark can be riskier due to poorly lit roads or animals on the road.
• Avoid driving under the influence. Penalties for this are severe, and DUI (Driving Under Influence) is punished severely.

What work and travel insurance policies are suitable for short and long-term stays in the US?

• Is the trip to the US and your return sufficiently covered? Are you sufficiently covered before, during and after your activities? Which insurance best suits your trip and your activity? Read more about insurances for abroad on JoHoinsurances.org.

What emigration and expat insurance can you take out for the United States if you are going to live there for a while?

• Whether you need health insurance when immigrating to the United States depends on where you come from and what kind of visa you get. In any case, it is strongly recommended that you take out your own private health insurance because of the extremely high costs of medical care. It is also often the case that your employer, if they do offer insurance, does not cover everything.
• Read more about insurances for abroad on Expatinsurances.org.