{"id":945,"date":"2022-11-21T10:00:00","date_gmt":"2022-11-21T09:00:00","guid":{"rendered":"https:\/\/carexpat.com\/blog\/?p=945"},"modified":"2025-07-10T14:27:49","modified_gmt":"2025-07-10T12:27:49","slug":"assurance-maladie-universelle-et-assurances-privees-comment-fonctionne-le-systeme-de-sante-aux-usa","status":"publish","type":"post","link":"https:\/\/carexpat.com\/blog\/assurance-maladie-universelle-et-assurances-privees-comment-fonctionne-le-systeme-de-sante-aux-usa\/","title":{"rendered":"Syst\u00e8me de sant\u00e9 aux USA : fonctionnement des assurances sant\u00e9 priv\u00e9es"},"content":{"rendered":"<p><!-- divi:paragraph --><\/p>\n<p>Le syst\u00e8me de sant\u00e9 aux Etats-Unis est un des meilleurs au monde (infrastructures et \u00e9quipements de pointe, professionnels qualifi\u00e9s) mais aussi, un des plus co\u00fbteux&#8230; Il n\u2019y a pas de protection sociale universelle, le syst\u00e8me repose majoritairement sur les assurances de sant\u00e9 priv\u00e9es. Voyons de fa\u00e7on plus d\u00e9taill\u00e9e comment fonctionne ce syst\u00e8me de sant\u00e9, et comment faire en cas de voyage ou d\u2019expatriation aux Etats-Unis.<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:heading --><\/p>\n<h2 class=\"wp-block-heading\">Un syst\u00e8me qui repose sur les assurances priv\u00e9es<\/h2>\n<p><!-- \/divi:heading --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Aux Etats-Unis, il n\u2019existe pas de r\u00e9gime g\u00e9n\u00e9ral universel d\u2019<a target=\"_blank\" href=\"https:\/\/carexpat.com\/blog\/s-assurer-pour-les-etats-unis-et-obamacare\/\" rel=\"noopener\">assurance maladie<\/a> comme il existe en France. De plus, les frais de sant\u00e9 aux USA sont parmi les plus chers au monde. Pour vous donner un exemple, une simple consultation chez un m\u00e9decin g\u00e9n\u00e9raliste peut <a target=\"_blank\" href=\"https:\/\/carexpat.com\/blog\/cout-dune-assurance-sante-aux-usa-et-cout-medical-que-couvrent-les-assurances\/\" rel=\"noopener\">co\u00fbter jusqu\u2019\u00e0 $230 en fonction de l\u2019Etat<\/a>. Comment font les habitants ? Ils n\u2019ont d\u2019autre choix que de souscrire \u00e0 une assurance sant\u00e9, publique ou priv\u00e9e, pour profiter d\u2019une prise en charge totale ou partielle de leurs frais de sant\u00e9 (il existe en effet des assureurs priv\u00e9s et d\u2019autres publics).<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>A noter aussi que le syst\u00e8me aux Etats-Unis repose sur la notion de service. Ces entit\u00e9s, qui peuvent \u00eatre publiques ou priv\u00e9es, ach\u00e8tent en effet des services de sant\u00e9 aupr\u00e8s de fournisseurs d\u2019acte de sant\u00e9, ou <em>health care provider<\/em>, qui ne sont autre que les praticiens, m\u00e9decins, p\u00e9diatres, infirmiers, etc.<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:quote --><\/p>\n<blockquote class=\"wp-block-quote\"><p><!-- divi:paragraph --><\/p>\n<p>A savoir : les entreprises de plus de 50 employ\u00e9s sont dans l\u2019obligation de proposer une assurance \u00e0 leurs collaborateurs (qui travaillent plus de 30 heures par semaine). Les entreprises prennent ainsi en charge une grande partie des co\u00fbts, une autre partie, une cotisation, est ensuite directement pr\u00e9lev\u00e9e sur le salaire de l\u2019employ\u00e9. La couverture propos\u00e9e par les employeurs n\u2019est pas toujours suffisante. Beaucoup choisissent alors de souscrire \u00e0 une assurance sant\u00e9 compl\u00e9mentaire afin de b\u00e9n\u00e9ficier d\u2019une meilleure prise en charge.<\/p>\n<p><!-- \/divi:paragraph --><\/p><\/blockquote>\n<p><!-- \/divi:quote --><\/p>\n<p><!-- divi:heading {\"level\":3} --><\/p>\n<h3 class=\"wp-block-heading\">Focus sur les 3 fournisseurs principaux d&rsquo;assurance priv\u00e9e<\/h3>\n<p><!-- \/divi:heading --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Les fournisseurs d\u2019assurance sant\u00e9 priv\u00e9e sont class\u00e9s en 3 cat\u00e9gories.<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:list --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul><!-- divi:list-item --><\/p>\n<li>Les <em>Health maintenance organizations<\/em> ou HMO : ici, le plan d\u2019assurance donne acc\u00e8s \u00e0 un r\u00e9seau de professionnels et d\u2019\u00e9tablissements. Pour b\u00e9n\u00e9ficier d\u2019une couverture sur leurs frais de sant\u00e9, les b\u00e9n\u00e9ficiaires doivent recevoir des actes m\u00e9dicaux de ces professionnels et\/ou \u00e9tablissements list\u00e9s.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Les<em> Preferred provider organizations <\/em>ou PPO : il existe l\u00e0 aussi un syst\u00e8me de r\u00e9seau, de professionnels et d\u2019\u00e9tablissements, mais le b\u00e9n\u00e9ficiaire peut faire appel s\u2019il le souhaite \u00e0 d\u2019autres m\u00e9decins (qui sont ext\u00e9rieurs au r\u00e9seau). Simplement, la prise en charge sera moins importante.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Les<em> Indemnity insurances <\/em>ou II : ici, les assur\u00e9s cotisent en fonction des risques qu\u2019ils souhaitent couvrir. Plus les risques sont \u00e9lev\u00e9s, plus les cotisations le sont.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- \/divi:list --><\/p>\n<p><!-- divi:quote --><\/p>\n<blockquote class=\"wp-block-quote\"><p><!-- divi:paragraph --><\/p>\n<p>A savoir : les compagnies d&rsquo;assurance sont aussi class\u00e9es par cat\u00e9gorie en fonction du niveau de couverture. On distingue alors :<\/p>\n<p><!-- \/divi:paragraph --><\/p><\/blockquote>\n<p><!-- \/divi:quote --><\/p>\n<p><!-- divi:list --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul><!-- divi:list-item --><\/p>\n<li>la <em>Catastrophic coverage<\/em> qui ne prend en charge que l\u2019hospitalisation en cas d\u2019urgence ou d\u2019accident,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Bronze qui prend en charge 60% des frais de sant\u00e9,<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Silver (75%),<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Gold (80%)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>et Platinium (90%).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- \/divi:list --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Au moment de souscrire, il faudra aussi v\u00e9rifier les termes de <em>co-payments<\/em>, franchises (ou <em>deductible<\/em>) \u00e0 l\u2019acte ou annuelles&#8230; Autant de termes qui font r\u00e9f\u00e9rence \u00e0 des frais \u00e0 la charge de l&rsquo;assur\u00e9.<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:heading {\"level\":3} --><\/p>\n<h3 class=\"wp-block-heading\">Qu\u2019en est-il des infrastructures de sant\u00e9 ?<\/h3>\n<p><!-- \/divi:heading --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Les Etats-Unis disposent de la m\u00eame fa\u00e7on d\u2019infrastructures publiques et priv\u00e9es. Les deux proposent un personnel qualifi\u00e9, des \u00e9quipements de pointe et des \u00e9tablissements modernes. Cela dit, les \u00e9tablissements publics tendent \u00e0 \u00eatre satur\u00e9s et les d\u00e9lais d\u2019attente pour les patients peuvent \u00eatre longs. Pour b\u00e9n\u00e9ficier d\u2019une prise en charge rapide, les \u00e9tablissements priv\u00e9s sont souvent pr\u00e9f\u00e9r\u00e9s (bien que co\u00fbteux).<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:heading {\"level\":3} --><\/p>\n<h3 class=\"wp-block-heading\">Pas de r\u00e9gime universel de sant\u00e9 ?<\/h3>\n<p><!-- \/divi:heading --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Il n\u2019y a pas de s\u00e9curit\u00e9 sociale \u00e0 destination de tous les habitants, de syst\u00e8me universel comme il existe en France. Il existe cependant une protection sociale qui couvre les personnes dans le besoin (\u00e2g\u00e9es de plus de 65 ans et\/ou avec certaines incapacit\u00e9s et les individus et familles poss\u00e9dant de faibles revenus). On parle ici respectivement des syst\u00e8mes Medicare et Medicaid.<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:heading --><\/p>\n<h2 class=\"wp-block-heading\">De quelle assurance avez-vous besoin pour un voyage ou une expatriation aux USA ?<\/h2>\n<p><!-- \/divi:heading --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Que ce soit dans le cadre d\u2019un voyage touristique (visa touristique de 3 mois) ou d\u2019une expatriation, on recommande toujours de partir aux Etats-Unis, attestation d\u2019assurance en poche. C\u2019est la garantie de voyager l\u2019esprit l\u00e9ger, un acte de pr\u00e9vention en quelque sorte.<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n<p><!-- divi:list --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul><!-- divi:list-item --><\/p>\n<li>Dans le cadre d\u2019un voyage, on recommande de souscrire \u00e0 une assurance voyage qui prend en charge les frais de sant\u00e9 mais aussi la responsabilit\u00e9 civile (en cas de dommages mat\u00e9riels et\/ou physiques caus\u00e9s \u00e0 autrui), le rapatriement, et propose une assistance en cas de besoin disponible 24 heures sur 24 et 7 jours sur 7.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- divi:list-item --><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>En cas d\u2019expatriation, on vous recommande dans un premier temps de discuter avec votre futur employeur afin de savoir quel type d\u2019assurance il propose, et ce qu\u2019elle couvre. Si cette couverture ne vous semble pas suffisante, il est conseill\u00e9 de souscrire \u00e0 une <a href=\"https:\/\/carexpat.com\/blog\/lassurance-sante-aux-etats-unis-pour-les-expatries-quelle-assurance-sante-internationale-choisir-en-cas-dexpatriation\/\">assurance sant\u00e9 compl\u00e9mentaire internationale pour expatri\u00e9s<\/a> qui offre l\u2019avantage de vous proposer une couverture aussi effective en France, en cas de retour ou de court s\u00e9jour dans votre pays.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><!-- \/divi:list-item --><\/p>\n<p><!-- \/divi:list --><\/p>\n<p><!-- divi:paragraph --><\/p>\n<p>Pour en savoir plus sur les organismes de sant\u00e9 aux Etats-Unis ainsi que sur l\u2019assurance sant\u00e9 internationale, et ses prestations, n\u2019h\u00e9sitez pas \u00e0 consulter notre site carexpat.com<\/p>\n<p><!-- \/divi:paragraph --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Le syst\u00e8me de sant\u00e9 aux Etats-Unis est un des meilleurs au monde (infrastructures et \u00e9quipements de pointe, professionnels qualifi\u00e9s) mais aussi, un des plus co\u00fbteux&#8230; Il n\u2019y a pas de protection sociale universelle, le syst\u00e8me repose majoritairement sur les assurances de sant\u00e9 priv\u00e9es. Voyons de fa\u00e7on plus d\u00e9taill\u00e9e comment fonctionne ce syst\u00e8me de sant\u00e9, et [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":6636,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[10],"tags":[135,101,131],"class_list":["post-945","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-conversion","tag-etats-unis","tag-expat","tag-voyageur"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Comment fonctionne le syst\u00e8me de sant\u00e9 aux USA ? 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