Health insurance in the United States is renowned for its complexity and sometimes exorbitant costs. Many people, whether expatriates, international students or even permanent residents, find themselves trapped by uninformed choices.
The main mistakes made by policyholders are detailed. To help you make the right choices, here’s an enriched summary, optimized to help you understand the key points and avoid unnecessary expense.
Why is it important to choose the right health insurance in the USA?
Unlike many countries, the United States does not have a free universal healthcare system. Each mistake in selecting coverage can cost thousands of dollars.
A good choice of health insurance allows you to :
- Drastically reduce medical expenses.
- Access to a network of reliable doctors and hospitals.
- Anticipate future needs (preventive care, maternity, chronic illnesses).
“Sophie, a French expatriate, chose insurance at $150/month without checking the deductible: the result was $6,000 in costs after a simple operation.”
7 common health insurance mistakes in the USA
Taking out health insurance in the USA can quickly become a headache, especially for expatriates or newcomers. Between the complexity of plans, differences in coverage and technical terms (such as deductible, copay or out-of-pocket maximum), it’s easy to make mistakes that can be very costly. A wrong decision can result in astronomical medical bills, limited access to care, or the inability to change plans before the next enrollment period. To avoid these pitfalls, here are the 7 most common health insurance mistakes in the USA.
Don’t compare insurance plans
Many people choose their health insurance solely on the basis of the monthly premium. However, this is only one element among many, and often the least representative of the real cost. A seemingly inexpensive plan may conceal a very highdeductible, i.e. the amount you have to pay before the insurance begins to reimburse you. Then there’s thecopay, the fixed fee you have to pay for each consultation or medical procedure, and theout-of-pocket maximum, which is the maximum amount you’ll have to pay out-of-pocket in a year. Failure to analyze these factors can expose you to very high unexpected bills.
Ignoring the provider network
In the United States, most health insurance plans work with a network of accredited doctors, hospitals and specialists. If your regular doctor or the hospital of your choice is not part of this network, costs can be exorbitant, or even not covered at all. It is therefore imperative to check the list of providers before taking out a policy. Simple negligence can result in the loss of thousands of dollars for out-of-network hospitalization or surgery.
Believing that out-of-network care is covered
Many people mistakenly believe that their insurance will cover at least part of the cost of out-of-network care. The reality is quite different: in most cases, such care is not reimbursed, or only at a very low rate, leaving an enormous out-of-pocket expense. For example, an emergency visit to an out-of-network hospital can cost several thousand dollars, not to mention a full hospitalization.
“Out-of-network hospitalization can cost $15,000 or more, not reimbursed.”
Neglecting preventive care
American insurance policies often include a package of free preventive care, such as vaccinations, annual check-ups or screenings for certain diseases. If you don’t take advantage of these, you’re missing out on a free service that can save you from serious and costly problems in the long term. A simple screening can detect a disease at an early stage and save you considerable medical costs in the future.
Santexpat.fr, la nouvelle façon de
s’assurer à l’étranger
1. Meilleurs prix
- Sans surcoût sur les tarifs assureurs,
nous comparons + de 300 offres d’assurance
2. Simplicité
- Un parcours simple pour sélectionner votre
solution en quelques clics
3. Accompagnement
- Nos conseillers sont là pour un
accompagnement 100% personnalisé
Not using available financial aid
The American system provides assistance in the form of tax credits and subsidies to make health insurance more affordable, notably via the Marketplace. Many people ignore these aids and pay full price for their coverage, which can represent double the actual cost. Checking your eligibility for these programs is an essential step in reducing your out-of-pocket expenses.
Thinking you can easily change plans
Contrary to popular belief, it’s very difficult to change health insurance outside the annualOpen Enrollment period. Except in the case of special events such as marriage, birth or moving house, you’ll have to wait until the next enrollment period to make any changes. This rigidity can be very penalizing if you’ve chosen the wrong plan at the outset.
“Not comparing can result in an overage of $3,000 to $8,000 per year depending on the plan.”
Not anticipating future needs
Many people choose their plan based on their current state of health, without thinking about what might happen in the coming months or years. Yet anticipating pregnancy, chronic illness or regular treatments is essential to avoid unsustainable costs. A simple error of anticipation can transform affordable insurance into coverage that is totally unsuited to your needs.
Practical advice on choosing the right health insurance
Choosing the right health insurance in the USA requires more than simply comparing monthly premiums. It’s essential to analyze the overall cost, taking into account not only the premiums, but also thedeductible and theout-of-pocket maximum. These elements determine the amount you could actually pay in the event of a health problem.
Before signing up, make sure that your usual doctors, as well as the hospitals where you wish to be treated, are included in the plan’s network of providers. An error in this respect can result in considerable costs if you need to consult outside the network. What’s more, it’s important to find out exactly what you’re covered for outside the network: in most cases, treatment is reimbursed very poorly, if at all.
Another often overlooked aspect is preventive care. Many plans offer free vaccinations, check-ups and screenings. By taking advantage of these services, you can not only preserve your health, but also avoid much greater costs in the long term.
Finally, don’t underestimate the financial assistance available through the Marketplace, such as tax credits or grants. They can considerably reduce your monthly bill. To make the best choice, you also need to anticipate your future needs: pregnancy, chronic illness or regular treatments need to be taken into account at the outset, to avoid unsustainable costs later on.
Recommended video: Health Insurance in the USA
To find out more, watch the full video below:
This comprehensive resource will help you better understand the intricacies of health insurance in the U.S. and avoid costly mistakes.
US health insurance glossary
- Premium (insurance premium): amount paid each month to be insured, whether or not you use healthcare services.
- Deductible: amount you must pay yourself before the insurance begins to reimburse you for your care.
- Copay (ticket modérateur / fixed co-payment): fixed fee paid for each medical consultation, examination or drug purchase (e.g. $20 per visit).
- Coinsurance: percentage of medical expenses you must pay after reaching the deductible (e.g. 20% of the cost of an examination).
- Out-of-Pocket Maximum: maximum amount you’ll have to pay out-of-pocket per year. Once this threshold is reached, the insurance covers 100% of covered expenses.
- Network (healthcare network): a group of doctors, hospitals and clinics partnering with your insurance company. Treatment outside this network is often much more expensive.
- In-Network vs. Out-of-Network: care provided within the approved network(in-network) or outside it(out-of-network), with very different reimbursements.
- Open Enrollment: annual window during which you can apply for or change your health insurance.
- Special Enrollment Period: possibility of modifying your plan in the event of a major life event (marriage, birth, move, job loss).
- Subsidies / Financial aid: reductions granted by the government to lower the cost of premiums according to income.
Your health insurance before leaving for the USA
Choosing health insurance in the United States isn’t just an administrative formality. It’s a decision that has a direct impact on your health and your budget. By avoiding the 7 most common mistakes, you can not only save thousands of dollars, but also benefit from appropriate and secure care.
Before signing up, take the time to compare, anticipate and inform yourself. And don’t hesitate to consult the experts at Santexpat.fr.
