USA – Health Insurance and Medical Circumstances

Medical Insurance available in the USA
Types of Insurance in the USA and medical circumstances

Health Insurance and Medical Circumstances in the United States

The public health insurance system is a very different in the United States. In in the USA, only eligible persons can join the public medical insurance system. The main public health insurance programs are Medicare and Medicaid. Medicare is a federal government-managed system for people over the age of 65, people with disabilities, and people with severe kidney problems that require dialysis and transplantation. The target is operated by the state government and the federal government. Therefore, those who are not covered by these programs need to consider private insurance coverage. 

  • Indemnity

 In general, in the case of Indemnity, medical institutions are free to choose, and they can call a specialist without referrals. In some cases, the doctor may claim the medical expenses directly to the insurance company, and the insurance benefits may be obtained from the insurance company, and then the insurance claimant may be asked for the difference. You may have to claim insurance benefits.

  • PPO (Preferred Provider Organization)

 PPO is a network formed by an insurance company contracting with a medical institution such as a hospital or a doctor. In the case of using a medical institution in the network, a discounted rate pre-arranged for payment of medical expenses is applied. Although the use of medical institutions outside the network is also possible, the burden on the insured person is usually greater than the use of medical institutions in the network. PPO is currently the mainstream in medical insurance for employees, and although there are regional differences, about 50% use PPO.

  • HMO (Health Maintenance Organization)

 The insured person designates a primary care physician (Primary Care Physician) who is a member of the HMO network, and the medical care practitioner instructs the appropriate medical care. Generally, insurance is not applied when using a medical institution outside the network except in an emergency.

  • POS (Point of Service)

 It is an intermediate plan of PPO and HMO. In general, the point that you have to specify the attending physician is similar to HMO. Generally, within the network, it is possible to use other medical institutions without the referral of the attending physician. When using a medical institution outside the network, referral from the attending physician may be necessary, and the burden on the insured person may be greater than that of the medical institution in the network.

  • HDHP (High Deductible Health Plan)

A plan with a higher self-paying amount (disclaimer) compared to the conventional insurance plan, which allows for tax-free contribution / funding for the purpose of paying medical expenses such as Health Reimbursement Arrangement (HRA) and Health Savings Account (HSA). Can be used in conjunction with a medical accumulated account. 

 Dental Insurance

The treatment contents into three kinds of preventive treatment, basic treatment and expensive treatment, and apply different Co-Insurance to create a plan. 

Vision Correction Insurance

Vision correction insurance, as the name implies, is a test for correction of vision and insurance for eyeglasses. Treatment for eye diseases and injuries is covered by medical insurance. 


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