The Magic of the 15th, or What Immigrants Need to Know About Insurance in America

Everyone - even those who do not live in America - knows that medicine is expensive in the USA and that health insurance is a must for a normal life in the country. Some may have heard the word ObamaCare but have a rather vague idea of ​​what it means. This is where the knowledge of most immigrants about health insurance in America usually ends. Those who fled to the United States from the war or took asylum for another reason have especially poor knowledge. They did not have time to plan the move and sort out the situation.

For such people, we, together with the New York insurance company Fidelis care compiled a guide to medical insurance in America. It contains the basic information and basic concepts that are necessary in order to obtain insurance in the United States.

Magic on the 15th

Those who have lived in the US for a long time and have not encountered any force majeure circumstances can take out insurance during the open enrollment period in November-January of each year.

But if you have recently arrived in the United States or have faced circumstances that change your status or family composition (dismissal from work, divorce, marriage, birth of a child), you can (re)apply insurance at any time.

And here comes the magic on the 15th.

“The magic is that if you start applying for insurance before the 15th of the current month, then the policy will begin to operate from the 1st of the next month, that is, not long to wait. And if you issue a policy on the 16th and later, then you will have to wait for insurance for a month and a half, ”explained in Fidelis care.

In practice, it looks like this: if you apply for insurance before May 15 (inclusive), then from June 1 you will already have coverage. And if you start registration, for example, on May 16 or later, then the policy begins to operate only from July 1.

On the subject: Personal experience: my father ended up in the hospital without insurance. How we got MedicAid and closed accounts for $200

Things to know when choosing insurance

1. Premium (premium) - a fixed amount that the insured pays to the insurer every month for participation in the health insurance plan.
2. deductibles (so-called deductible) - the amount that the patient must spend on medical services from his own pocket before insurance coverage begins to operate.
3. Copayments – additional payment from the patient's pocket for the service/drug in addition to what is covered by the insurance. Usually this is some percentage of the cost of the service.
4. Network – a network of doctors and hospitals with which your insurer has a price agreement. Health care services received “out of network” will be more expensive, and deductibles and copays will be higher. Therefore, when applying for insurance, be sure to look at the list of medical institutions in your “network”, especially if you are already cooperating with a doctor.
5. maximum out-of-pocket (maximum out-of-pocket expenses) is the limit on the amount a patient can pay for medical services during the year, including co-payments and deductibles. If you were sick a lot or received expensive procedures, and reached this limit in a few months, then the insurance company has no right to demand additional payments and deductibles from you until the end of the year. The out-of-pocket maximum for all ObamaCare plans in 2023 is $9 for an individual or $100 for a family.

A detailed glossary of all insurance terms can be found on the US Department of Health website. here to register:.

What are the insurance

If you divide as roughly as possible, then insurance can be paid and free.

Paid the employer provides (such insurances have their own variety, they need to be discussed directly with the employer), or you can buy such a policy yourself. In this category, so-called metal insurance plans are available to New Yorkers from New york state of health, they are divided into five categories:

1. Bronze plan provides the lowest monthly fees and the highest deductibles and copays.
2. Silver plan: on it you will pay average monthly premiums.
3. Gold plan provides monthly insurance premiums above average.
4. Platinum plan requires the highest monthly premiums from customers, but at the same time provides the lowest deductions and co-payments. It is suitable for people who need serious medical care or those who have the ability to pay high premiums.
5. Catastrophic plan provides low monthly fees, but high deductibles. It is difficult to execute (you will need to collect a lot of documents) and has very limited application for a number of conditions (income, age, etc.). If you are interested in this insurance plan, it is best to discuss your options with a specialist.

The cost of a particular health insurance plan is determined based on several indicators:

• location;
• total family income and the number of insured persons in the family;
• age (child, adult, senior 65+);
• the state of health of the insured person(s), in particular, pre-existing condition, i.e. chronic diseases or diseases requiring long-term treatment (asthma, diabetes, cancer). You can find out more about this here to register:.

The New York State of Health website has calculator, which will help you roughly calculate the cost of insurance for you. You need to enter data on income, the number and age of people who will be covered by insurance, and it will give you the cost of the plan you are interested in in different insurance companies.

Free insurances are mostly income-based and often depend on immigration status. These policies include Essential Plan, Medicaid, and CHILD HEALTH PLUS (CHP). We described in detail how to get free insurance policies in America, in this stuff. You can read about insurance for different categories of immigrants here и here.

How to get insurance

You can buy health insurance in New York through New York State of Health website. But if you are new to the US, it is still better to use the services of professionals so as not to overpay and get a clear explanation of how the insurance system works in the US.

insurance company specialists Fidelis care They will select the policy that suits you and sort everything out. Consultation is available in Russian. Phone: (347) 642-2993, e-mail: [email protected]

IMPORTANT: Before calling your insurance company, gather your thoughts and prepare the following information:

• immigration status;
• family composition;
• income;
• the age of the children (if they are part of the policy);
• chronic diseases;
• medicines and doctors you need and their insurance requirements.