Vitae Group is one the most sought-after insurance agencies amongst foreigners for Health Insurance in the United States. We are prepared to meet the needs of those who seek our services, to protect your greatest asset: your health. We represent virtually every insurance company in the market, providing a full range of services.
Unlike health plans in Brazil, Health Insurance in the U.S. does not pay directly all of your medical expenses. Depending on the insurance you buy, the costs may be split between you and the insurer.
There are several items an insurance policy might have that make sharing costs easier for the client, like Deductible, Coinsurance, Copays, and Out-of-Pocket Maximum. The more items your policy has, the more benefits the client gets.
The amount you pay during the policy period before the insurer begins covering the costs, whether all or in part.
Example 1: Let’s say that Mr. Smith has a policy in place with a $2,000 deductible.
Mr. Smith has to be hospitalized, and the expenses reach $50,000, so he will pay the deductible only ($2,000), whereas the Health Insurance will cover the remaining $48,000.
Example 2: Let’s assume that Mr. Jones’ insurance, whose coverage has just started, has a deductible of $2,000. A doctor visit regularly costs $200. According to the rates negotiated between the insurance company and the doctor, the visit would cost $120.
During the consultation, the doctor requested an exam that would cost $500 if Mr. Jones was uninsured, but he pays $200 for the exam because of the insurance.
Subtracting the money he has spent so far ($120 for the consultation and $200 for the exam), his deductible is now $1,680 which Mr. Jones is responsible for paying before the end of the contract. This amount decreases as Mr. Jones uses his insurance within the policy period.
Example 3: A month after the doctor's visit and the test described in example 2, Mr. Jones gets into an accident. Hospitalization costs add up to $200,000.
Mr. Jones will pay only the remaining amount in the policy – in this case, $1,680. The insurance company will pick up the rest ($198,320).
With coinsurance, you pay a percentage of the cost of your medical care, and the insurer picks up the rest – please note that the percentage is set when negotiating with insurance plans. Coinsurance always has a limit, which starts after you reach the deductible amount.
Example 1: Let’s say that Mr. Davis’ plan has a:
● $2,000 deductible
● $5,000 coinsurance with 20% participation
Mr. Davis had to be admitted to the hospital, and the stay cost $10,000. First, he will pay the deductible amount ($2,000).
There are still $8,000 due to the hospital, and Mr. Davis will pay only 20% of that (i.e., $1,600), while the insurer will pay the other 80%.
Example 2: Now suppose Mr. Davis has the same insurance as in example 1, with a:
● $2,000 deductible
● $5,000 coinsurance with 20% participation
Mr. Davis had to be admitted to the hospital, and the stay cost $102,000. First, he will pay the deductible amount ($2,000).
Since the policy’s coinsurance has a $5,000 limit, this is what Mr. Davis will pay of the remainder of the hospital bills. The insurer will bear the rest of the costs.
The copay is a fixed amount for in-network care provided by some insurance plans. Copays do not count towards your deductible, nor to your coinsurance.
Example: Suppose Mrs. Hill has a Health Insurance policy in place with the following copays:
● general practitioners (GP): $30
● specialists: $50
● urgent care centers: $75
Whenever she sees one of the in-network providers, Mrs. Hill will pay the fixed amount defined in the policy, regardless of her deductible, her coinsurance, and how much they usually charge. These copay amounts do not apply to her deductible or coinsurance, and only to the out-of-pocket maximum.
This benefit gives you a limit on the amount of money you have to spend in addition to your premiums. Once your medical bills hit the cap within the policy period, the insurer will pick up the remaining costs.
Copays, deductibles, and coinsurance are included in the expenses that count toward this limit.
Example: Let’s say Mr. Smith’s Health Insurance offers the following:
● $2,000 deductible
● $5,000 coinsurance, with 20% participation
● $30 copays for medical visits
● $7,000 of out-of-pocket maximum
Throughout the insurance policy period, Mr. Smith has had five doctor’s appointments, for which he paid $150.
Before the period expired, Mr. Smith was admitted to the hospital, and the stay cost $100,000.
If we do the math, Mr. Smith should pay:
● $2,000 deductible
● 20% coinsurance participation (in this case, $20,000)
● Total amount payable: $22,000
Because the policy Mr. Smith took out has a $7,000 out-of-pocket maximum, he will pay out only the cap minus the money for medical visits ($150) – in other words, Mr. Smith will pay the hospital only $6,850, and the insurance company will shoulder the rest.
Depending on the Health Insurance you take out, it is possible to choose between one of the following plans:
HMO (Health Maintenance Organization)
It requires you to first see a previously chosen primary care provider (PCP), who will prescribe appropriate treatment or refer you to a specialist if needed.
PPO (Preferred Provider Organization) / EPO (Exclusive Provider Organization)
It allows you the freedom to visit a specialist directly if you so wish, without first having to consult with your primary care provider.
With some Health Insurance policies, you might get care only in a specific region, like the city or state where you reside, or anywhere in the world – e.g., you are living abroad but wants to have access to healthcare services in Brazil or a third country.
Taking your current circumstances into account, you can choose between these two categories of coverage:
Ideal for people living and working in the U.S. Your Health Insurance covers all hospitals, clinics, and labs in their network of providers (typically more regional, in your county, or state). To this end, you have to confirm you live in the United States and, depending on the plan, give proof of your migration status.
Perfect for those living outside Brazil, but who rather have health checks in this country. Health Insurance covers the vast majority of services, barring potential limitations. You will have the freedom to get care wherever you want, without restrictions of borders or doctors. It is also an interesting option for those who travel a lot outside their home country.
Unlike Brazil, there is no universal healthcare in the United States. Low-income people, the elderly, war veterans, and people with disabilities rely on government plans such as Medicaid, Medicare, and Obamacare, for medical assistance.
Medicaid provides health coverage to low-income adults, children, pregnant women, and people with disabilities. The program is administered by states and funded jointly by them and the federal government. It is available only to U.S. citizens or permanent residents who fulfill the eligibility requirements.
*Vitae Group does not provide healthcare services for Medicaid
For people age 65 or older who meet certain income criteria. People with disabilities and those who have severe kidney illness can also qualify for Medicare. The program is available only to U.S. citizens or permanent residents who fulfill the eligibility requirements.
*Vitae Group does not provide healthcare services for Medicaid
The Patient Protection and Affordable Care Act – PPACA is commonly known as Obamacare because it was signed into law by then U.S. President Barack Obama on March 23, 2010. It makes it easier for low-income people to pay for Health Insurance and guarantee their right to medical assistance and hospital care.
