When I arrived in the U.S., I faced two challenges: filing taxes and choosing a health insurance plan. In my home country, Lebanon, health insurance was straightforward, with minimal to no features and choices. The U.S. system, however, was a different story—one packed with terms and decisions that may be overwhelming. Today, my PhD dissertation is on U.S. health insurance. But who would have thought I'd write a dissertation on this topic four years ago? It's a journey that took an unexpected turn, and I'm excited to share my knowledge with you.
If you are an international prospective student, this blog is for you. To all Rice students, this is your gentle reminder to sign up for health insurance: https://studenthealthinsurance.rice.edu/
Healthcare costs in the U.S. can be daunting, even with insurance.
Tip #1: Check service costs upfront to budget and anticipate healthcare expenses more effectively.
So, first things first: here are some cost-related terms to know.
- Premium: The amount you pay each month or year for your health insurance plan.
- Deductible:The amount you must pay out-of-pocket for healthcare services before your insurance begins to pay.
- Copay: The fixed dollar amount you pay for services like doctor visits or prescriptions, usually at the time of service after you've met your deductible.
- Coinsurance: This is similar to copay, but it's a fixed percentage amount you pay for services after you've met your deductible.
- Maximum Out-Of-Pocket: The cap or maximum dollar amount you pay for healthcare services in a plan year.
Health insurance plans often have a group of doctors, hospitals, and other healthcare providers, typically known as a healthcare “network."
Tip #2: To avoid unexpected bills, check if doctors and hospitals are in-network before scheduling appointments or procedures.
Here's what you need to know about networks:
- In-network: Doctors, hospitals, and other healthcare providers labeled as “in-network” have agreed to a contract with your insurance company to provide services at specific rates (e.g., copays, and coinsurance rates).
- Out-of-network: This group includes providers who haven't agreed to the insurance company's rates.
Now, let's dive into the world of health insurance plan types, each with its own unique features and requirements.
Tip #3: Carefully check your plan type and what requirements it has.
Here are a few key types of plans to keep in mind when making your choice:
- Health Maintenance Organization (HMO) plans: These plans offer less flexibility when choosing doctors and typically require staying in-network. HMOs demand that you choose a primary care physician (PCP) and get referrals from them to see specialists.
- Preferred Provider Organization (PPO) plans: Compared to HMOs, PPO plans offer more flexibility in seeing specialists without referrals, both in and out of the network.
If you liked this blog, stay tuned for more on U.S. health insurance and healthcare!
About the author:
Salpy Kanimian is from Beirut, Lebanon and is a PhD candidate in Economics. She got her dual degree in Economics and Mathematics at the American University of Beirut prior joining Rice. Read more.
Further Reading:
How I get my life together with Notion—quite literally
Houston Without a Car: How to Navigate Rice University and Beyond