As you embark on your adventure to move to the mighty United States, one of the most important aspects you’ll need to navigate is the U.S. healthcare system.

Unlike many countries with government-run healthcare, the U.S. relies heavily on private health insurance. This can make understanding how to access and afford healthcare very tricky for newcomers.

Here’s a quick rundown of everything you need to know about U.S. health insurance in 2024.

The Basics

Health insurance in the U.S. is primarily provided through employers, government programs, or purchased individually. The U.S. does not have a single-payer system like the NHS, so individuals are responsible for securing their own coverage.

There are three main avenues for obtaining health insurance in the U.S.:

• Employer-Sponsored Insurance: This is the most common form of health insurance in the U.S. If you have a job offer, your employer may provide a health insurance plan, often with the employer covering a significant portion of the premium. If an employer can afford to bring over a Brit, they should be able to offer good health insurance. Make sure you check before signing any contracts!
• Government Programs: Programs like Medicare and Medicaid provide coverage for specific groups. Medicare is for individuals aged 65 and older or those with certain disabilities, while Medicaid offers coverage to low-income individuals and families.
• Individual Market: If you’re self-employed or your employer doesn’t provide insurance, you’ll need to purchase it through the individual market. The Health Insurance Marketplace is a government-run exchange where you can compare and buy plans.

Types of Health Insurance Plans

There are different types of health insurance plans, each with its own cost structure and level of flexibility in choosing healthcare providers:

• Health Maintenance Organization (HMO): Requires you to use a network of doctors and hospitals. You’ll need a referral from your primary care doctor to see a specialist. (A primary care physician is similar to a GP; they are the person you go to for general health concerns, who will send you to specialists if needed.)
• Preferred Provider Organization (PPO): Offers more flexibility by allowing you to see specialists without a referral and use out-of-network providers, though at a higher cost.
• Exclusive Provider Organization (EPO): Similar to an HMO but does not require referrals; however, you must use the plan’s network.
• Point of Service (POS): Combines features of HMOs and PPOs, requiring referrals for specialists but offering some out-of-network coverage.

Cost Considerations

Understanding the cost of health insurance in the U.S. is crucial. You’ll encounter several terms that affect how much you’ll pay:

• Premium: The amount you pay monthly for your insurance plan.
• Deductible: The amount you pay out-of-pocket before your insurance starts covering expenses.
• Copayment (Copay): A fixed amount you pay for specific services, like doctor visits.
• Coinsurance: The amount you (the insured) must pay after meeting your deductible. This is usually a fixed percentage of the total cost. An 80/20 split is common, and would mean you paying 20% of the cost, while your insurer pays the remaining 80%
• Out-of-Pocket Maximum: The maximum amount you’ll pay in a year, after which insurance covers 100% of expenses.

How Much Will I Pay?

That all depends on what plan you get, and whether you need to use it.

Unfortunately, healthcare insurance premiums have increased significantly in recent years — by about 50% in the last decade, in fact — and this growth shows little sign of slowing.

Last year, the average yearly premium for an individual was around $8,500. Family coverage cost an average of about $24,000. 

Remember, though, that much of this was paid by employers as part of their benefits packages. According to research by KFF, workers actually only paid about $6,500 for family plans and $1,700 for individual plans.

In 2024, average premiums for employer-sponsored coverage are expected to continue rising. That means you might be paying more than the averages listed above.

Equally, you could pay far less. Costs vary wildly, and can be influenced by age, location, plan type, and other factors. For example, workers at larger companies generally had to pay less for their coverage than those at smaller companies.

Navigating the Health Insurance Marketplace

Again, if you’re purchasing insurance on your own, the Health Insurance Marketplace is your primary resource.

The “Open Enrolment” period for 2025 starts on November 1, 2024, and lasts through January 15, 2025. (However, dates can vary by state.) During this period, you can compare different plans, see if you qualify for subsidies based on your income, and enrol in coverage.

Subsidies, or premium tax credits, are available to those with household incomes between 100% and 400% of the federal poverty level. For 2024, the expanded subsidies under the American Rescue Plan are still in effect, making health insurance more affordable for many people​.

Some states offer more generous government-run health insurance plans. Make sure to check the requirements and benefits offered by the local government where you’ll be living. These systems are often Byzantine and might seem intimidating at first, but they can save you — financially and literally — in the long run.

Pre-existing Conditions and Essential Health Benefits

One of the key protections under the Affordable Care Act (ACA) is that insurers cannot deny coverage or charge higher premiums for pre-existing conditions. 

Additionally, all ACA-compliant plans must cover a set of Essential Health Benefits, including:

• Emergency services
• Hospitalisation
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs

This comprehensive coverage ensures that your basic healthcare needs are met, although the extent of coverage can vary by plan.

To Sum Up

Understanding the health insurance system is vital for anyone planning to move to the U.S. While it can seem complex, taking the time to understand your options and the costs involved will help you make an informed decision.

Whether through employer-sponsored plans, the Marketplace, or government programs, securing the right coverage is essential for your peace of mind and financial security.

Remember, it’s always better to be making this decision now, rather than when you actually need coverage.If you need further information, the Healthcare.gov website is an excellent resource for understanding your options and finding coverage that suits your needs.