United States

How the Medical system works in the US

Even though the cost of medical expenses is very high in the US, there is no local healthcare insurance system. However, there is a public system intended for a certain category of people which is divided into two different programs: Medicaid and Medicare:

• Medicaid is intended for impoverished people and families (around 11% of the population)
• Medicare covers people over the age of 65 and the disabled (around 15% of the population)

The rest of the population has no choice but to take out private health insurance, either via their employer or on an individual basis.

A significant share of American people are not covered by any insurance plan as they earn too much to be able to benefit from Medicaid but not enough to afford private individual insurance.

In 2009, with a view to implementing a “fairer” healthcare system, President Obama presented his new reform on the American healthcare system (ACA, Affordable Care Act). This reform has been implemented progressively and aims at enabling all Americans to access medical care and to benefit from basic health coverage. 

Visiting a doctor in the US

American GPs see their patients in their office or in private clinics and, in general, from Monday to Saturday, from 8.30 am to 6.30 pm. Certain clinics are also open on Sunday.

If you have taken out private insurance, you can only see a doctor who belongs to the medical network of your private insurance. He/she will become your treating doctor.

During the consultation, you will be treated by a nurse who will check your blood pressure, ask you if you are currently on medication, and ask you to describe your symptoms. You will then wait for the doctor to examine you in a small room. In general, doctors take care of several patients at the same time and consultations only take a few minutes (10 to 15 minutes maximum).

Consultation fees vary depending on whether you are insured or not. Therefore, do not be surprised if one of the first things you are asked when making your appointment is to know if you have health insurance, and which insurance, since fees vary from one insurance plan to another. For the same service provided, consultation fees vary from $80 to $300 on average. Read more about how MetLife Worldwide Benefits provides insurance in the US on our Accessing Care in the US page.

Specialist doctors in the USA

In the case of a more specific disease, your treating doctor will refer you to a specialist from the medical network of your insurance company. These doctors are called “in-network” doctors. If you see a specialist doctor without being referred by your treating doctor and/or an “out-of-network” specialist, you will most likely receive a lower reimbursement from your insurance company.

As is the case for GPs, consultation fees with specialists vary significantly. Most of the time, fees are higher for consultations with specialists than consultations with GPs. Fees may start from $150 and reach excessive amounts (around $300 for a consultation).

Being admitted to hospital in the US

American hospitals use advanced technology and high-quality medical equipment. Medical staff also provides high-quality care. There are three types of hospitals in the USA:

Public hospitals

Public hospitals where you can be admitted without having an insurance plan. Still, they are not free. If you are not covered under an insurance plan and you have to pay a significant amount for your medical expenses, hospitals may allow you to pay by installments. In all cases, you will have to pay the entire bill.

Private hospitals

As is the case for consultations with GPs, you will be asked to show your insurance card before any medical procedure. Consultations are conducted in the same way as consultations with GPs: a nurse provides the initial medical care, and then the doctor sees the patient or the planned surgery is performed. In general, there are emergency services in order to see a doctor as fast as possible, who will then refer you to the appropriate department following the diagnosis. The bill will be sent later on for this service and is usually very high.

Walk in clinics

Walk-in-clinics operate in the same way as consultations with GPs. There are more and more walk-in-clinics becoming available in the United States. They are slightly cheaper than hospitals and also provide emergency services. 

In case of emergency in the USA: call 911 for rapid intervention.

Buying medication in the US

Drugs can be bought in pharmacies, which are often located within supermarkets and different store chains. There are many pharmacy chains in the US.

As is the case for consultations, drugs are very expensive. The cost of generic drugs is often lower but they need to be specifically indicated on the prescription in order to be delivered.

In the United States, drugs are delivered on a personalized basis: you will receive the exact number of pills or capsules needed depending on the duration of your treatment.

As for over-the-counter drugs, they can be bought in specific shops and in supermarkets.