In this article, we'll have a super informative chat with Alexandre Bacci, a Florida-licensed insurance agent, who will explain a little about how health insurance works for those who are coming to the United States, who are going to spend some time or who are actually going to live here. 

This is one of the questions people ask me the most:

How does health insurance work in the United States?

The best option is always to talk to a specialist and Alexandre is the person I recommend to my clients.

He will analyze your family structure to indicate the best option for you to come with peace of mind, whether you're coming for a season or to live.

Bruna: Alexandre, can you introduce yourself and tell us a little about your experience as a health insurance agent?

Alexandre: My name is Alexandre Bacci, I have been a licensed agent for five years in the United States. I work with health insurance and health plans. Let's explain the difference. 

What is the difference between health insurance and health insurance in the United States?

Health insurance is the option for those who don't have sufficient "migratory status" to use a health plan or Obama Care.

Bruna: When you talk about 'sufficient migratory status', what does that mean?

‍Alexandre: When the person is going to live here, either as a student or as a tourist with an expected change of status, and they are going to file a tax return here in the United States from the following year in which they are going to start using the plan, they can use the Obama Care law.

‍Bruna: Right. So, when we talk about status, it would be when the person declares income tax.

Alexandre: Yes. If the person comes here as a tourist, their status is that of a tourist, and then they cannot yet access the Obama Care law.

The Obama Care Act is a law that entitles you to a tax credit, which is a discount that you get on a domestic plan through your tax return. 

Bruna: So he gets a tax credit to pay for his health insurance?

Alexandre: Exactly. Here, comparing with Brazil: in Brazil, we have the SUS, which gives you a public hospital and options without you having to pay. Not in the United States. Here, the government helps you pay for health insurance.

Bruna: So you get an income tax credit and therefore you need to file an income tax return to get that credit.

Alexandre: Exactly. This credit represents an amount that we get according to our income.

Those who earn more have a lower credit and discount - the health plan is more expensive.

Those who earn less and declare a lower income get a bigger discount and, in this case, the health plan will be cheaper.

There is a lot of variation from one family to another, because incomes vary so much.

‍

‍

Who can take out a health plan in the United States?

‍Bruna: So, if we're talking about a student who comes here and doesn't declare income tax, because he came on a student visa, he wouldn't be able to apply for Obama Care.

‍Alexander: I couldn't.

‍Bruna: However, if the student declares income tax, he - even with a student visa - could apply for Obama Care.

‍Alexandre: You could, because the I20 is a valid document. The I20 is a document that the student receives when they are authorized to come to the USA as a student. 

As a student, he doesn't have to file a tax return, but if he wants to use Obama Care, i.e. have a better domestic plan, he has to file a tax return.

‍Bruna: Right. Let's imagine the following: the student came to study, he has no income, because he can't have income, because he's studying. So how would he benefit from Obama Care?

‍Alexandre: In that case, he would have to go to an accountant to see what the possibilities are. He can look into the options of what to declare, including the remittances he brings to live in the country.

Often, the remittance that his parents send him or that he brings back from Brazil can be considered income and can be declared.

This is a little outside my expertise, but an accountant will be able to tell you whether you need to have an IT Number to declare tax, whether you need to mirror the tax you declare in Brazil here or whether it's not necessary. 

Each case is different, but he can declare and, by declaring, he can access good health insurance options.

‍Bruna: So, the Obama Care health plan is affordable if you file a tax return, regardless of your status.

Alexandre: You need to have a legal status in the country and declare tax - it's those two things together.

What are the healthcare options in the United States?

‍Bruna: If the student or anyone else is coming here, what is their way of being insured when they come to the United States?

‍Alexandre: In this case, there are health insurances that have an emergency nature. So, if you break a limb, have an accident, have appendicitis or any other kind of situation in which you need care, it wouldn't be suitable for routine consultations, nor will it cover pre-existing conditions, but you protect yourself from cases in which the bill is higher. 

So, to give you an idea: appendicitis surgery here can cost between $60,000 and $80,000 with a two-day hospital stay.

‍Bruna: So if you don't have insurance, you pay the full price?

‍Alexandre: That's right. Which ends up being unfeasible. The routine part, sometimes a person wants to go to the doctor once a year, it's easier for them to pay $150 to $200 dollars (the average cost of visits), but with an emergency like a broken arm, for example, we're talking about $15,000 to $20,000 dollars. 

Everything here is very expensive in the medical field, right Bruna?

‍Bruna: How long does this insurance last?

‍Alexandre: You can do it for as long as you want, between 5 days and two years. 

If the person stays for more than two years, they need to take out a new policy two years later with the updated age. In this case, the price is no longer the same, but it can be renewed every two years.

‍

‍

What is the cost of health insurance in the United States?

‍Bruna: On average, what is the cost of emergency insurance?

‍Alexander: The cost depends a lot on your age, obviously. But on average for a person in their 30s, we're talking about $80 to $100 dollars per month, per person. 

For children it's cheaper, already in the $60 range, but it depends on the amount of cover you put on.

These coverage amounts can vary between $50,000, $100,000, $500,000 and one million dollars of coverage.

‍Bruna: Which ones do you use the most?

‍Alexandre: I always indicate at least $100,000, because I base it on an appendicitis surgery. 

‍Bruna: It's true! Appendicitis can happen to anyone at any time. 

‍Alexandre: In my professional opinion, $50,000 is not enough. If the procedure costs $60,000, you'll have to pay the other $10,000. So I think $100,000 of cover is the minimum. In this case, you still have the deductible.

The deductible is the deductible, which is how much you pay when you use it. So you take it into account if you want to pay less or nothing at all. 

If you don't want to pay anything when you use it, the monthly fee will be more expensive.

‍Bruna: Would that be for the health insurance or the plan?

‍AlexandreThat's true for both. If you have a lower deductible, you'll have a higher monthly fee.

‍Bruna: In an example of a 35-year-old woman who is coming to the United States, I take out $100,000 in coverage, I can pay $100 a month. If something happens to me, an accident, I go to the emergency room. 

Let's say the bill came to $30,000, how does the deductible work?

‍Alexandre: On a range of $100 dollars a month, you'll have a deductible of $100 to $250 dollars. 

So, if you break an arm and go to the hospital, you'll pay $250 and the insurance would pay the rest. The deductible is your share of the costs.

If you have a sore throat or something simpler, for example, you don't need to go to hospital. 

That's pretty cool to explain: here there's the hospital and the urgent care. These are smaller clinics, but they are very different from Brazil.

In Brazil, if you have a sore throat, you go to the hospital and there's an emergency room. It's different from the United States, because here the hospital doesn't have a smaller emergency room, it's at a separate address.

This is one of the main mistakes Brazilians make. When they get sick, they go to hospital. 

When they go, the bill is very high and it's not the right place to go, because here in the United States, we should only go to the hospital in life-threatening or fracture situations.

If it doesn't involve a life-threatening fracture, you should go to Urgent Care, which will cost you much less. In these cases, you pay a co-payment of $25 dollars. 

At Urgent Care, you are seen and leave with a prescription for an antibiotic or the remedy for the problem and it's solved.

‍Bruna: What illnesses should people seek Urgent care for instead of the hospital? Sore throats, colds...

‍Alexander: Whenever there's something that's not serious, like a fever - a fever is an emergency and it's something that needs to be dealt with. But it's not an emergency that's considered life-threatening.

So, if you have a strange pain, it could be appendicitis or nothing, for example. In this situation, it's best to go to the hospital, because if you go to Urgent Care, they won't have the structure to analyze you properly.

‍Bruna: The person who comes as a tourist, they usually take out insurance in Brazil, which is also useful. 

‍Alexandre: You can do it both from Brazil and from the United States. The advantage of taking out insurance in the USA is that you don't need that reimbursement system.

In the case of insurance taken out in Brazil, you pay in the United States and then settle up with the insurance company. 

If you have American insurance, you can go to the hospital with a card and only pay your share. There's no need for reimbursement.

It's very simple and sometimes even cheaper.

‍Bruna: How does the process work? How long does it take? Let's say I live in Brazil and I'm going to the United States in December for 20 days. Can I contact you and say that I'm going with my two young children and ask for 20 days' insurance?

‍Alexandre: We managed to do it 48 hours before we arrived in the country. In fact, I can do it from today to start tomorrow night, but it's important not to leave it to the last minute. 

If a person is traveling, for example, leaving Brazil on the 1st and arriving on the 2nd, they can take out insurance on the 1st, because they already have all the benefits in case of lost luggage.

It's travel insurance, but it has better benefits because it's made in the United States.

Insurance here is easier because you already have the network, you already have the card, there's no reimbursement system, which makes it much easier.

‍Bruna: This is a common concern for people who want to come to the United States, live here and leave Brazil. Usually, the first question is about the high cost of insurance. 

That's usually scary, but what I understand is that a family of four would spend an average of $400 a month.

‍Alexandre: Those who are arriving are still converting the currency. They're thinking about how $400 dollars will be R$2000 reais. But when you live here or have an income in dollars, it's totally feasible.

The problem here is that you don't have a public health system.

In the case of appendicitis, for example, the person will be operated on.

There are no negatives here. Whether you have insurance or not, the account is settled later.

Now, if the person has something that needs treatment, you can't do it. Here it's a problem to have cancer and not have a plan, because it's all private.

So, you go to a clinic where you get chemotherapy, you have to pay before you get it.

In this case, for example, if you have cancer and have health insurance, it won't solve anything, because it's only for emergencies. So, with the insurance you can treat pain and do some tests, but after that the insurance is no longer useful.

If you have health insurance, you can have treatment, but always keep an eye on the waiting periods. 

Each case is different.

The great thing is that there are always options for all types and ages.

What we need to do is size up what that family needs, especially in cases where there are people with health problems that require more attention or greater control.

If you have health insurance and diabetes, it doesn't cover diabetes-related care.

So sometimes this person needs to have a plan, while the rest of the family has insurance. That way, they can get the care they need without compromising the whole family's budget.

‍Bruna: What about pregnant women? Is there any insurance or plan that can be taken out?

‍Alexandre: The funnel narrows a lot and becomes a bit more limited, but there are options even without any kind of grace period.

It's much more advantageous, because the plan protects you from complications or the need for an ICU, since a day in the ICU costs $45,000 dollars.

So, you can take a birth package that exists here, but with the plan, you'll spend less money and be better protected.

‍Bruna: So, if the person files a tax return, they have the advantages of having the discount or the credit to apply for Obama Care, tell me what is the minimum and maximum income to have this advantage of this law that gives you this tax credit?

‍Alexander: Let's use the example of a family with two children. There are four people in total. The minimum income for a family of four is $26,500 net per year. 

It depends on the person's income and conditions. If the person works here and earns a W2, which is a document received through a contract with a company, they should consider their gross income.

If the person is self-employed, they can deduct expenses. 

The closer you get to the minimum value, the cheaper the health plan will be further away from the ceiling.

Today, the ceiling is $203,000 a year. Up to this income, she gets a discount, but a smaller one.

‍Bruna: So the minimum would be $26,500 and the maximum $203,000.

‍Alexander: That, the amount varies every year according to the government's adjustments.

With the pandemic, the ceiling has increased to help.

There are periods to take out a health plan - whether you want to renew, change plans or take out a new one.

With the pandemic, these periods are now longer. And that's for residents.

‍Bruna: For those who have passed this period, how does it look afterwards? Does that mean I won't have insurance for the rest of the year?

‍Alexandre: No, there's a window of exceptions. When you cross the border into the United States, you have 60 days to get health insurance, regardless of the time of year.

If the person has changed status, if they had a tourist visa and have changed to a student visa, they have 60 days to make the health plan. 

There are a few exceptions. But when she arrives from Brazil, there is a 60-day window in which she can make the plan.

Health insurance, on the other hand, can be taken out at any time of the year.

‍Bruna: Let's say I live here and I forgot to make the plan. What would that situation look like?

‍Alexandre: In 2021, it could be done at any time of the year because of the pandemic. The information we have so far is that this date will be extended to next year.

But it's good to plan ahead.

For those who are coming, you can't just count on the changes that will happen, because there's no certainty.

‍

‍

How does dental insurance work in the United States?

‍Bruna: What about dental insurance? How does that work? 

‍Alexandre: Dental insurance is a bit more boring. 

Because it's not under Obama Care, the law doesn't cover dental insurance and has shortages.

It also requires a Social Security or IT number, which must exist for the individual. 

You can get a dental plan - based on a fixed amount or a percentage of the dentist's fee.

And dentists are expensive here. 

That's why, if you're going to Brazil every year, it's better to do it in Brazil, it'll be cheaper.

If you have to make a channel in the United States, you'll spend a lot more than $2,000 dollars.

If you have a dental plan, you will pay 40% of this amount or a flat rate.

‍When doyou spend a fixed amount or a percentage?

If you use the care network, you pay a fixed amount, you can benefit more and spend less.

‍Bruna: What would the care network be?

‍Alexandre: It's the dentists who are in those networks that accept a specific plan.

If the dentist is in the network, you'll pay a fixed amount that's in the table. If you go to a dentist of your choice outside the network, you will pay a percentage of the dentist's fee.

So you end up spending more, because it depends on how much the dentist costs.

‍Bruna: And what is the cost of the dental plan?

‍Alexandre: It's cheap, around $25 a month for an adult. That's for all types of care. 

The dental plan is very detailed, with a price for each tooth and each type of procedure.

You need to analyze the case to see if it's worth it. For example, there are cases in which the person, during the change of status, cannot go to Brazil.

And since everything is expensive here, insurance ends up protecting us.

I'm a bit biased, but it's a protection that you need to take into account when planning.

‍Bruna: That goes for health insurance, life insurance. We pay so we don't have to, but it's good to have that peace of mind.

How does the tax return work to get the Obama Care tax credit?

‍Bruna: For the resident, I've heard that this tax credit, which we get from Obama Care, is based on our income when we're doing our taxes. However, you have to say how much you think you'll earn during the year. What happens when I earn a lot more than I expected? What's the difference?

‍Alexandre: In that case, you have to pay the difference in the tax credit. That's because we now have to plan for the following year. So we tell the health insurance company: my estimated income for the following year, 2023, which I'm only going to declare in 2024.

You need good planning.

An analysis will then be made based on your income, the region in which you live and you will receive a specific amount for the discount.

If your income is higher than what you declared, you need to reconcile the amounts.

Your accountant can do this for you.

When you file your tax return, you'll have to make up for the discount you received. For example, if you earned more than you declared, your rebate should have been lower and you will therefore have to pay the difference when you file your tax return.

It's not a fine, it's a reckoning.

You can also update your income during the year and this will also update your discount amounts.

The opposite also happens. There are people who believe they are going to receive an income and end up receiving less than expected.

It's always good to have a plan, because you start thinking in annual terms. Everything is related to what you earn and spend each year.

It's a change of mentality. It's different from Brazil, but here it's very important because he takes all the estimates and prepares the country's budget.

Bruna: Where can people find you?

Alexandre: People can find me on WhatsApp, which is +1 (321) 946 8297. People can send me a message.

It's a very personalized job, whether you're coming for a vacation or to live, according to your family's needs and what you can afford.

‍

And of course, if you're interested in starting the process of moving to the United States, check out the real estate opportunities for living or investing with our team of consultants at Selecta. Contact us by clicking here.

‍

I invite you to watch my video "HEALTH IN THE USA: Health Insurance and Health Plans for IMMIGRANTS, STUDENTS, TOURISTS".

‍

‍