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Intro to Health Insurance and 10 terms you need to know in 2024

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Health insurance is an overwhelming task when you first plan your move to the United States. You keep hearing that it's crucial and essential, but what exactly do you need to know and how can you start to investigate your options? Well here's a great snapshot introduction into the space!

Why do I need health insurance in America?

The quality of healthcare can vary widely around the world.  The quality of care in your new country may not be to the standard you were used to back home.  Also, as a foreign national, you and your family will not likely be entitled to any free or subsidized healthcare.

It is therefore important to consider an expatriate health plan to provide for the healthcare needs of you and your family.

  1. Annual Out-Of-Pocket Maximum: An annual out-of-pocket maximum is the most you’ll pay for covered health care costs during one plan year. If you meet the out-of-pocket maximum, your health plan will pay for all your covered health care costs for the rest of the year.
  2. Claim: A claim is a payment request to your health insurance. When you get care from an in-network doctor or other provider, they send a claim to your health insurance carrier, and ask to be paid for services. This payment is based on the services covered under your health plan.
  3. Coinsurance: When you pay coinsurance, you pay a percentage of your covered health care cost. For example, you may pay 20% of your costs. Your health plan pays the rest. Your coinsurance usually starts when you meet your deductible (depending on your plan). This is different from a co-pay.
  4. Co-pay, Co-payment: A co-pay, or co-payment, is the amount you pay at a doctor's appointment, usually at the time of the visit/service. It is a set amount, such as $15 or $30.
  5. Cost Sharing: Cost sharing is a payment you make for health care or medication. Your co-pay, coinsurance, and your deductible are all types of cost sharing.
  6. Deductible: Your deductible is the amount of money you need to pay for care per year before your health plan begins to help pay for care. An individual deductible is for you alone. A family deductible is for all the members of your family who are covered by your health plan.
  7. In-network and out-of-network: Insurers have particular providers (e.g. doctors and hospitals) who are “in” their network and there are the others who are “out” of their network. As a general rule: The bigger the company, the bigger the network, and therefore you have more access to “in-network” services for an included cost in your insurance.
  8. Maximum Benefits Amount or “Benefits Maximum”: Your health plan may define a total amount it will pay for services in a plan year. This is the maximum benefit amount. For example, it may only pay a certain amount on prescription drugs. After you reach your benefit maximum, you pay for prescriptions on your own.
  9. Plan: Your plan explains the benefits you get as a member. That means the things your health plan will pay for. It also explains what is not covered by your plan, in the limitations and exclusions.
  10. Policy: Your policy explains the benefits you get as a member of a health plan. These are the things your health plan will pay for. It also explains what is not covered by your plan, in the limitations and exclusions.
  11. Premium: Your premium is the amount you pay to your insurance carrier in order to have a plan. Premiums are often paid monthly.

What is expatriate health insurance?

Expatriate (or “expat”) health insurance is designed for those who are living and working abroad.  It is designed to give you and your family access to the best healthcare possible, wherever you are in the world.

Health insurance for new arrivals to America

I wrote a whole article all about the types of insurance available to new arrivals.

Personally, I used Cigna Global, a service that exists outside of the U.S. but provides coverage inside as an expat.

Instead of using the exchanges, and comparing coverage that way, I found that Cigna Global could provide me with better coverage for less money, and I jumped on it.

I have now had a doctor visit and a dentist visit, and both were completely covered by my insurance but everyone is different, do your research, and ask lots of questions!

Josh Pugh

Josh Pugh

Josh is a business founding, digital marketing focused, charity driving, community builder from South Australia, living in New York City. After moving in 2017, Josh realized that there was an opportunity to curate and help the community of expats who moved to the United States – and launched America Josh. Josh is also the President of Variety – the Children's Charity of New York, Secretary at The Mateship Foundation, and Founder & CEO at Fortnight Digital.View Author posts

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