Health Insurance in the US is the nightmare that you expect. It's incredibly important that you assess your personal needs and take in as much information as you possibly can, so this should help you with a good introduction. It's very important that you get health insurance before you arrive and have it for the entire duration of your stay.
First things first, I want to introduce the concept of “health insurance” in the United States. Most importantly, what is not covered if you don't have insurance. This seems like a backward approach, but I need to really describe just how much strife you may find yourself in if you don't have appropriate cover.
What happens if you don't have health insurance?
The easiest way to describe this is to use a scenario: You're walking along the street with a coffee in hand, and you cross the road at the lights. You get hit by a car. You fly through the air and hit the ground with a not-so-gentle thud. You're awake, but you're in shock, and everything hurts.
From this point there is a high chance that somebody has already cost an ambulance ($) which will take you to a hospital for scans ($$) checks ($$$) analysis ($$$$) and potentially surgery or operations ($$$$$).
Let alone the fact that somebody else was involved in the situation (the person driving) and while you might think that they would be wholly responsible, it's going to take a very long time for you to get any money out of them or their insurer (insuring they're insured). You simply can't rely on this as the out of pocket expense will be immediate and devastating.
If you are not insured, there may be costs up-front as to ensure that your medical care is covered prior to it being done. This avoids the risk for the hospital that they won't get paid but means that the sick you sitting in a hospital bed has to come up with the thousands of dollars.
Among uninsured adults in 2015, a third (33%) were asked to pay for the full cost of medical care before they could see a doctor.
If your injuries are serious there is a very real chance that the costs for your care if you are uninsured will run into the hundreds of thousands of dollars or into the millions. All of which you will be required to pay.
What health insurance is available?
Health insurance is generally tied to your employer. So the first thing you will want to do when negotiating for a job is discuss with them the “benefits”. You will generally be presented with a range of options that you can select from different insurance companies depending on your needs.
Their options will also generally come in platinum, gold, silver, and bronze coverage levels which correspond to the amount of care you will be provided as “included” in the package.
The most important thing to do is read these detail for exactly how much you will be paying. Some terms that you need to know about healthcare can be found here and some traps that you might fall into can be found here.
Healthcare exchanges and how they work in America for expats
Normally if you want to get onto the healthcare exchange, you need a special reason, but if you are new to the country, have lost your job due to the COVID-19 crisis, you are eligible for a special enrollment period with the exchanges (see more here).
This means you can browse through insurance that is available at HealthCare.gov and learn to compare and contrast the different offerings.
Each different state has their own network of health insurance and will have their own web page that you can enroll on. Some are better than others but they're all worth the look.
Special Health insurance for expats
Personally, I’ve used Cigna Global, a service that exists outside of the U.S. but provides coverage inside as an expat.
I’ve found the coverage to be solid, and it covers everything related to Coronavirus symptoms and can be applied for now.
This is basically insurance that looks like travel-insurance but is not. It isn’t temporary, it’s proper health coverage, but just using an alternative method because you aren’t a citizen of the United States.
This is a really good option for anyone looking for health coverage when they first arrive in the United States and don't have a good option supplied by their employer for a competitive rate.
In the month of April, Cigna is offering free additional medical coverage via their Health & Wellbeing module on all policies*. This additional coverage is focussed around improving your overall wellbeing and encouraging a healthy, balanced lifestyle and includes things like routine exams, cancer screenings, wellness coaching and life coaching.
*Cigna reserves the right to amend or withdraw a promotion at any time without notice. Cigna Global health insurance policies sold between 01/04/23 and 30/04/23 are eligible to have the Health & Wellbeing module added to their policy for the lifetime of their cover. The additional cover may only be applied by telesales/broker support agent following an initial quote online. Only Global Individual policies are eligible (Cigna Global Health Options, Silver, Gold and Platinum cover). Minimum purchase value rules apply ($2k minimum premium).