American medical insurance is divided into social medical insurance and private medical insurance.

How much do you know about American medical insurance? Many people who go to the United States have a better understanding of American social system and life culture, but they have a little knowledge of American medical insurance. In view of this situation, I will tell you about the most common medical insurance in the United States, introduce their respective characteristics, and the kind of medical insurance that is more convenient to see a doctor. As we all know, the medical process involves both patients and doctors. No matter what kind of insurance you have, it may be helpful for you to choose medical insurance and see a doctor smoothly. The medical insurance system in the United States is very complicated, mainly including social medical insurance and private medical insurance.

Social medical insurance

1965, the us congress passed the medical insurance act, authorizing the government to establish social medical insurance. This mainly refers to the management of the federal government, mainly for retirees and the disabled? Medical care? Insurance (medical insurance, red card), operated by the state government, for low-income residents? Medical assistance? Insurance (Medicaid, also called white card in California), veterans can apply for veterans medical insurance (VA).

These are the medical insurance cards of the federal government. People in China like to call them red and blue cards. Medical insurance consists of two parts, part B pays for doctors and part A pays for hospitals. The most basic conditions for applying for medical insurance are American citizens over 65 years old and green card holders who have lived in the United States for five years (among other conditions). Medical insurance takes care of retirees, disabled people and patients with kidney disease who need long-term dialysis. There is no family income limit for applying for medical insurance, but you must pay the monthly fee. After receiving medical services, there are deductibles and co-insurance.

The above is the California low-income Medicaid insurance card. Because it is white, it is also called white card. Medicaid in every state in the United States is similar. The main care targets are low-income pregnant women,/kloc-children and adolescents under the age of 0/9, retirees aged 65 and over, the blind and the elderly who need to live in nursing homes.

Medicaid recipients enjoy free medical services, but their identity, age, length of residence, income and assets need to meet the prescribed conditions. Because of the current economic downturn in the United States, it is becoming more and more difficult to apply for this kind of insurance. Many American retirees who came from China with children's protection received Medicaid.

Some elderly people or disabled people may meet the above conditions of medical insurance and Medicaid at the same time, and these patients can enjoy double insurance of medical insurance and Medicaid. The above-mentioned medical insurance patients need to pay monthly fees, advance payments, etc. However, if the patient has Medicaid at the same time, the state government where the patient is located will pay such expenses. Under the current circumstances, these people don't need to spend a penny on medical treatment, hospitalization and living in nursing homes (most patients actually have no money). From the doctor's point of view, because of the double insurance, patients don't have to pay, and patients have high enthusiasm for seeing a doctor. The more doctors see, the higher their income. Many doctors like patients with medical insurance and Medicaid. Medical insurance and Medicaid, referred to as Medi-Medi, are called by many doctors and patients? Gold card? .

Private medical insurance

Private medical insurance in the United States is operated by private insurance companies, mainly PPO (accounting for 34%) and HMO (accounting for 3 1%). The full name of PPO is Preferred Provider Organization, and its advantage is that it can choose doctors freely. You don't need a referral from a primary care doctor (PCP), you can see an expert directly. The main problem of PPO is that the insurance premium is expensive, and patients need to pay part of the registration fee ('5 to 0 co-payment'). Every year, before the insurance company pays the medical expenses, patients have to pay (50 ~', 500 yuan), which means that PPO has deductible and * * * co-insurance.

Although PPO is free to choose a doctor, it is best to have its own family doctor. PPO can help you find a good family doctor more easily. If necessary, he or she will help you find a high-level specialist. After all, doctors will know each other better than outsiders. In addition, no matter what specialist you see, ask him/her to give your family doctor a copy of the case. Most specialists are interested in local problems, and it is also important for family doctors to master all your medical conditions.

HMO (Health Maintenance Organization) is characterized by low insurance premium, low registration fee for patients themselves and no insurance. The inconvenience of HMO is that you can't just look at the specialist. Before doing many tests or referring to a specialist, you need a family doctor to apply to the insurance company and get approval before you can do it.

These are some basic characteristics of PPO and HMO. If you are not sure whether your insurance is PPO or HMO, you can check your insurance card. Generally speaking, HMO's insurance card has the name or phone number of your family doctor, usually the doctor of your own choice or the doctor designated by the insurance company (see HMO insurance card below). Generally, there is no family doctor's name on PPO insurance cards.

Patient John's HMO insurance card, and Dr. John Smith in the blue circle above is the patient's family doctor (PCP). Not all HMO cards have PCP's name on them. From the doctor's point of view, people are generally more willing to see PPO patients, which is related to the payment method of insurance companies.

PPO is the same as Medicare and Medicaid, right? Service charge? Once a doctor sees a patient with PPO, he can get a consultation fee. The more they watch, the more they earn, and the higher their enthusiasm.

HMO on the contrary, what about the insurance company? Head fee "way to pay the doctor's consultation fee. As long as the patient chooses a family doctor, regardless of whether the doctor has seen the patient, the insurance company will pay him/her a certain consultation fee on a regular basis.

For example, John, a patient with HMO insurance card, chose Dr. Smith as his family doctor. Whether Dr. Smith has seen John or not, the insurance company will pay Dr. Smith 5 pounds every month, which is 5 X 12 = 180 dollars per year. If John doesn't see a doctor for a year, Dr. Smith will get' 80; If John sees a doctor twice a year, the cost of each consultation is 90 dollars (180/2); If John goes to see a doctor once a month, the cost of each consultation is only' 5 (180/ 12). In other words, the more times a doctor sees a patient, the less the cost of each consultation.

That's why HMO patients sometimes have an emergency, but they can't see a doctor right away. What insurance companies do is obviously purposeful, because the more times patients see a doctor, the more opportunities for examination and referral to a specialist, and the more money insurance companies spend. HMO is actually encouraging doctors to look at patients less in disguise. Of course, if the patient really has an emergency, the doctor must see the patient immediately. Because if something goes wrong, the doctor on the patient's insurance card cannot escape. In addition, the patient really went to the emergency room and spent the money of the insurance company, and the doctor could not explain it to the insurance company.

Lala miscellaneous said a lot, in fact, it is the following sentence:

1. If you live and work in the United States and meet the requirements, you can get medical insurance after you retire at the age of 65.

2. Would you be satisfied with Medi-Medi if you spent all your savings and entered a nursing home during the period from retirement to being unable to take care of yourself? Gold card? Conditions.

3. If you come from China and your children sponsor retired people to come to the United States, try to apply for Medicaid.

If you are PPO, you are lucky, so you must make good use of it. Although you can see a doctor at will, it is also important to find a good family doctor.

If you are HMO and want to see a doctor in a hurry, make your illness worse when you make an appointment by phone, which will help you see a doctor as soon as possible. However, after seeing a doctor, it is best to tell the truth and avoid overtreatment.

If you want to immigrate to the United States, you must make a quick decision and make a decision as soon as possible. If we grasp the current immigration policy and find a suitable immigration method, it will be much easier to immigrate to the United States.