Health Care in the United States
Information for Foreign Nationals
The United States does not have universal health care. According to the National Center for Health Statistics, the majority of people in the United States have private insurance to cover a portion of health expenses. Health insurance in the United States can be expensive, it is advantageous to work for an employer that offers health insurance benefits. Learn about health insurance plans for Children’s Mercy employees.
Private health insurance coverage
Private health insurance varies widely in coverage depending upon the insurance company and plan. Many plans will provide a list of providers, services, and prescription medications that are “in network,” which have been approved for insurance coverage. Out-of-network providers, services and prescription medications will either not be covered by insurance plans or be covered at a lower rate.
Premiums, deductibles, copayments and out-of-pocket maximums
To obtain health insurance, regular payments called “premiums” are required. These premiums go directly to the health insurance company to purchase a health insurance policy. Premiums must be paid regardless of if an insured person has medical expenses or not. Employers generally pay a large amount of premiums for their employees, but most companies, including Children’s Mercy, share the cost of premiums with employees. Children’s Mercy contributes to the cost of premiums for full- and part-time employees scheduled to work a minimum of 48 hours per pay period.
A deductible is the amount of medical costs that the employee (or person covered by the insurance policy) must pay each plan year before insurance coverage begins. The deductible amount varies by plan, but are generally expressed as a yearly maximum figure. For example, an individual with a $1,600 deductible will have to pay for the first $1,600 of medical expenses incurred before insurance coverage begins.
A copay is a fee that is owed each time you visit a medical provider. The fees vary depending on the level of care (i.e. primary care provider, specialist, emergency visit). Copays are also charged for tests, prescription drugs, physical therapy and other covered expenses. They are generally relatively inexpensive, but vary depending on the insurance plan. In a majority of insurance coverage plans, copays are not counted towards the deductible. Children’s Mercy’s Employee Wellness Center in the downtown Adele Hall campus offers employees enrolled in its medical plan no-cost preventive visits and a $10 copay for urgent and primary care as well as lab work.
The out-of-pocket maximum is the maximum amount of fees that the employee (or person covered by the insurance policy) will pay for covered services in a plan year. Once the out-of-pocket maximum is reached, the health insurance company pays 100% of the costs of covered benefits.