1) U.S. Healthcare System Literacy (Your Financial Shield)
Master insurance fundamentals (the vocabulary of survival)
Health insurance in America has its own language. Premium is your monthly payment—you pay this whether you use healthcare or not. Deductible is the amount you pay out-of-pocket before insurance kicks in (e.g., $1,500 means you pay the first $1,500 of care). Copay is a fixed fee per visit ($20 for a doctor, $50 for a specialist). Coinsurance is the percentage split after your deductible (80/20 means insurance pays 80%, you pay 20%). Out-of-Pocket Maximum ($10,600 in 2026 for individuals) is your safety cap—once you hit this, insurance covers 100%. Here's what trips up immigrants: 'preventive care' (annual physicals, vaccines) is free with no deductible. But the moment a test becomes 'diagnostic' (investigating a symptom), it's subject to your deductible. Ask before any test: 'Is this preventive or diagnostic?'
Depending on your insurance plan (HMO vs. PPO), you might need a hall pass to see a specialist.
- HMO (Health Maintenance Organization) plan requires a Referral. You must see your PCP first, and if they agree you need an expert, they write a referral. If you see a specialist without this, your insurance will pay zero.
- PPO (Preferred Provider Organization) plan gives you more freedom. You can usually skip the PCP and go straight to a specialist. However, you pay a higher monthly price for this convenience.
- In an HMO, your PCP acts as the gatekeeper to keep costs down. Always check your plan type before booking an appointment.
Free Resource: Understanding HMO vs. PPO and Referrals
Resources
Record your progress
Mark this subsection complete to track your progress.