The American healthcare system is quite specific in its structure, relying primarily on private medical institutions. This creates a highly competitive environment where medical centers invest heavily in cutting-edge technologies. In addition to that, the government itself spends around 18% of the national GDP on healthcare annually—approximately $4.5 trillion.

This investment is far from charitable; on the contrary, a financial return is expected, which is why medical services in the U.S. are far from affordable for everyone, especially for those without insurance.

In this article, we will explain how the American healthcare system works, what it is built upon, and how immigrants can navigate it.

Contents:

  1. Key Features of U.S. Healthcare
  2. Types of Medical Facilities in the U.S.
    1. Buying Medication in the U.S.
  3. Medical Service Costs in the U.S.
  4. Pros and Cons of the U.S. Healthcare System

Key Features of U.S. Healthcare

The foundation of the medical system in the USA is health insurance. Most medical services are paid through insurance coverage. While it’s technically possible to pay out-of-pocket, due to the high cost of services, insurance is used in the vast majority of cases.

Insurance is most commonly obtained through an employer; it is known as employer-sponsored insurance. Up to 90% of working Americans receive health coverage through their jobs. The employer signs a contract with an insurance company (e.g., Blue Cross, Aetna, UnitedHealthcare), and the employee typically pays 20–30% of the monthly premium, while the rest is covered by the employer. Often, these plans also extend to the employee’s family members.

The main government-funded health insurance in the USA is Medicare, but it is available only to senior citizens and people with disabilities. Medicare plans generally cover hospitalization, doctor visits, and sometimes prescription drugs. One of its key advantages is that enrollment is free or requires only a minimal co-payment.

Additional government programs

  • Medicaid is intended for individuals with low income (typically under $20,000 per year per person). Eligibility requirements vary by state, so access to this program depends on local regulations.
  • CHIP (Children’s Health Insurance Program) offers similar coverage to Medicaid but is specifically tailored for children in low-income families.
  • VA Health Care provides medical coverage for military veterans, offering a separate system of services and benefits.

Government US medical insurance costs nothing but it may involve additional out-of-pocket costs such as deductibles, copayments, or coinsurance. For individuals who do not qualify for these programs, it is possible to purchase a health insurance plan independently:

  • HMO (Health Maintenance Organization). is one of the more affordable types, averaging $456 per month. It covers treatment only within a designated network. Patients are assigned a primary care physician who coordinates further care and referrals to specialists.
  • PPO (Preferred Provider Organization) costs about $552 monthly, but allows for broader provider choice. Referrals aren’t needed, and policyholders can seek care both in- and out-of-network.
  • EPO (Exclusive Provider Organization) combines features of both: care is limited to a specific network like in HMO plans, but access to specialists doesn’t require a referral, offering more flexibility.

When purchasing medical insurance in the United States independently, there are also so-called “Metal Plans” (Bronze, Silver, Gold, and Platinum). These plans are based on the principle of cost-sharing between the policyholder and the insurance company. However, the costs are not split evenly; the approximate distribution is as follows:

Plan

Paid by Insurance Company

Paid by Policyholder

Bronze

~60%

~40%

Silver

~70%

~30%

Gold

~80%

~20%

Platinum

~90%

~10%

Here’s how it works: a person with a Bronze plan receives a hospital bill for $10,000. In this case, the insurance company would cover approximately $6000, while the remaining $4000 would be paid by the policyholder. Under a Platinum plan, the split would be much more favorable: the company would cover $9000, and the policyholder would pay only $1000.

At first glance, a Platinum US medical insurance plan may seem more advantageous. However, that’s not necessarily the case. While the insurer’s share of coverage is higher under Platinum plans, the monthly premiums are also the highest.

Average health insurance cost in America by plans:

Plan

Monthly Premiums

Bronze

$300–400

Silver

$400–600

Gold

$500–700

Platinum

$700–900

As a result, for people who rarely seek medical care, a Bronze plan is much more cost-effective than a Platinum one — and vice versa.

It’s worth noting that in the U.S., doctor visits are fairly frequent. This is because healthcare in the United States places strong emphasis on specialists (cardiologists, endocrinologists, orthopedists, and so on) rather than on general practitioners. This approach improves the quality of care for complex medical conditions but complicates coordination between providers.

Primary care physicians (PCPs) make up only about 12% of all doctors, which means that it’s rarely possible to resolve all health concerns in a single visit. As a result, patients with chronic conditions often see three to five different specialists. These specialists frequently work in different clinics or hospital systems, which can lead to issues with inconsistent medical records or delayed transmission of patient data.

Types of Medical Facilities in the U.S.

The primary type of the U.S. healthcare facility is the hospital. Hospitals offer a wide range of services, including emergency care, surgery, diagnostics, intensive care, and inpatient treatment. Top hospitals in the United States are Mayo Clinic in Rochester, Cleveland Clinic, Johns Hopkins Hospital and Massachusetts General Hospital.

The second most important type are outpatient clinics. These facilities provide care without hospitalization, including consultations, diagnostics (e.g., lab tests, ultrasounds), and minor procedures such as physical therapy. If a patient requires more specialized services, they may be referred to specialty clinics or diagnostic centers, which offer imaging studies like MRI (Magnetic Resonance Imaging), CT scans (Computed Tomography), and others.

Emergency medical care is provided either through hospital emergency departments or specialized Urgent Care Centers. In both cases, treatment is focused on stabilizing the patient until the immediate threat to life is resolved; afterward, the patient is referred to a hospital or clinic for follow-up.

There are also Federally Qualified Health Centers (FQHCs), which serve low-income individuals, immigrants, and the uninsured. However, these centers often have long wait times. In 2023 alone, FQHCs provided care to 31 million patients, accounting for approximately 10% of the U.S. population.

Buying Medication in the U.S.

Medications in the United States fall into two main categories: prescription drugs (require a valid prescription issued by a licensed physician and over-the-counter (OTC) drugs that are available without a prescription.

The primary place to obtain medications is the pharmacy. To purchase prescription drugs, a valid prescription must be provided — this can be done in person, by phone, via a mobile app, or through the e-prescription system (electronic transmission of prescriptions from the physician to the pharmacy).

Online pharmacies are rapidly growing in popularity. A patient registers via an app or website, uploads the required prescription to their profile, places an order, and receives the medication by delivery — typically within 1 to 5 days.

Difficulties with medicine in the U.S. often arise when someone tries to purchase medication using a foreign prescription, a situation common among tourists and temporary residents. The issue is that prescriptions issued by physicians not licensed in the U.S. are not legally recognized by American pharmacies and therefore cannot be filled.

To resolve this, the individual must visit a licensed U.S. physician. It is important to bring a detailed medical summary that includes medical history, diagnosis, and treatment plan. If the originally prescribed drug is not approved for use in the U.S., the doctor will prescribe a locally available equivalent.

Medical Service Costs in the U.S.

Roughly 80% of medical facilities in the United States are privately owned, which has led to a highly commercialized healthcare market and relatively weak government regulation of medical pricing. As a result, prices are primarily shaped by market mechanisms, with competition being the dominant factor.

However, large healthcare networks don’t necessarily compete for patients — they compete for qualified medical personnel. Providers attract specialists by offering higher salaries, and in turn, offset these labor costs by raising prices for services. This dynamic has led to situations where a routine visit to a primary care physician can cost $100—$200 out of pocket.

Average cost of medical care in the U.S. without insurance

Medical Service

Average Price

Comprehensive physical exam

$350–400

Urgent care (non-critical cases)

$125–300

Emergency Room visit – ESI level 3

$1500–3000

Emergency Room – mild cases (ESI 4–5)

$150–750

Overnight hospital stay (per night)

$3700

Outpatient visit

$450 in hospital, $108 at private practice

Blood test (CBC and basic panels)

$100–1000

Ambulance service

$1000–2500

Uncomplicated childbirth

$10,000–20,000

Average cost of specialized medical treatment in USA:

Procedure

Cost

Ultrasound (single region)

$153–345

MRI without contrast

$625–1600

MRI with contrast

$501–1026

Biopsy (general range)

$150–10,000+

X-ray (per region)

$100–300

Full-body MRI (preventive screening)

$1300–2500

Average cost of common health care services in the US:

Procedure

Cost

Appendectomy

$8500–35,000

Fracture treatment (non-surgical)

$2500+ (diagnosis + cast)

Fracture treatment with surgery

$17,000–35,000

Suturing a deep laceration

$165–425

Hip replacement surgery

$50,000–100,000

Chemotherapy (per cycle)

$10,000–30,000

Pros and Cons of the U.S. Healthcare System

The health system in the USA is far from unambiguous. On one hand, the U.S. leads the world in healthcare spending. On the other hand, it ranks far from the top in terms of healthcare efficiency. For instance, according to the Commonwealth Fund’s 2024 international healthcare system performance study, the American healthcare quality ranked last in efficiency among high-income countries. Let’s break it down starting with the advantages:

  • Cutting-edge medical technologies. Intense market competition drives innovation, which is why the U.S. is a global leader in the development and adoption of medical technologies. Hospitals and clinics are equipped with state-of-the-art diagnostic and treatment systems. Pharmaceutical companies in America develop the most new medications in the region.
  • High medical professionals. Physicians undergo an extensive education path: 4 years of undergraduate studies, 4 years of medical school, and 3 to 8 years of residency. They are also required to maintain licensure through Continuing Medical Education (CME), which ensures up-to-date knowledge and clinical competence.
  • Low rate of medical errors. Strict personal liability for medical malpractice helps keep error rates relatively low. In complex cases, diagnoses are often reviewed by multiple physicians. In oncology, for example, treatment is typically reviewed by a Tumor Board. It is a multidisciplinary panel of specialists who jointly develop and approve care plans.

Disadvantages of medicine in America:

  • High cost of medical services. Healthcare in the U.S. is extremely expensive without insurance. For example, if a tourist suffers a closed traumatic brain injury, the resulting hospital bill can range from $13,000 to $23,000. Even with insurance, out-of-pocket costs for such cases can still reach $2,200 to $10,000.
  • Limited access to healthcare in america. As of 2024, 8.6% of the population — about 28 million people — were uninsured. As a result, many delay or avoid seeking medical help due to the financial burden. In rural areas, which are home to 20% of the U.S. population, there is a well-documented shortage of physicians and hospitals. For example, in Mississippi, there are only 65 doctors per 100,000 people, compared to 200 per 100,000 in New York.
  • Bureaucracy in the insurance system. While the number of basic insurance plan types is limited, there is a proliferation of providers, each with its own policies and reimbursement procedures. The biggest challenge lies in claims processing. In 2024 alone, 18% of insurance claims for medical services were denied, often due to bureaucratic delays, administrative errors, or incomplete documentation.