The Healthcare System in Guam: Health Insurance, Public Hospital, Emergencies and Health Risks

There is no universal health insurance fund in Guam comparable to French Sécurité sociale. The system combines three tiers. The American federal programmes form the first: Medicare, for people aged 65 and over, and Medicaid, for low-income households. The second is territorial: the DPHSS administers Guam’s Medicaid and handles public health; CMS refers requests for information on Medicaid and on the Children’s Health Insurance Program (CHIP) to it. The third consists of employer insurance and individual contracts, which are supervised by the Guam Department of Insurance, attached to the Department of Revenue and Taxation.

Funding of Guam’s Medicaid is mixed: the MACPAC commission indicates that the federal contribution rate was permanently set at 83% by the 2023 appropriations act, and Medicaid.gov specifies that Guam extended the programme to low-income adults on 1 January 2014 and has covered, since 1 January 2021, lawful residents under the Compacts of Free Association (Micronesia, Marshall Islands, Palau). More than 30,000 people are enrolled in Medicaid and CHIP (Medicaid.gov). The care sector is divided between the public hospital, clinics and independent practitioners.

Medicare is for people aged 65 and over. According to the CMS guide on coverage options for immigrants, US citizens and qualified immigrants with at least 40 quarters of contributions receive Part A, hospital cover, without a premium. Without enough quarters, Part A can be purchased, with a reduced monthly premium from 30 quarters and a higher one below that. Part B (doctors and outpatient care) involves a monthly premium and an annual deductible; permanent residents must show five years of continuous residence for Part B. The Part A hospital deductible is also revised every year.

Guam’s Medicaid: CMS explains that many qualified immigrants must wait five years after obtaining their status before accessing Medicaid and CHIP, with exceptions such as refugees. The conditions applicable to a French national should be confirmed with the DPHSS (telephone 671-635-4421, email publichealth@dphss.guam.gov according to CMS). Employer insurance and individual contract: for insurance taken out by oneself or by an employer that operates only in Guam, it is the Guam Department of Insurance that provides information (telephone 671-635-1840). Finally, CMS reminds us that a Guam resident is not eligible for the federal Marketplace.

The official sources consulted describe no uniform organisation of primary care doctors in Guam, nor any published consultation fees. In practice, access to practitioners depends on the insurance contract: the employer’s insurer or the individual contract specifies the care network and deductibles, which should be read before any planned consultation. An uninsured expat pays for care on site; Assurance Maladie (French health insurance) specifies that, outside the European Union, only urgent and unforeseen care can possibly be reimbursed exceptionally on return to France.

For medicines, no official list or tariff was read for Guam. A chronic treatment should be prepared before departure with the family doctor, and France Diplomatie recommends consulting a doctor or an international vaccination centre well before leaving. Details of reimbursement by situation are in the page healthcare reimbursement in Guam.

Guam Memorial Hospital (GMH), in Tamuning, 850 Governor Carlos G. Camacho Road, is run by the Guam Memorial Hospital Authority, a component of the Government of Guam. Its website describes it as the only public hospital in Guam, with a licensed capacity of 158 acute-care beds, plus 40 licensed long-term beds in its skilled nursing facility; another page of the same site mentions a 203-bed facility and more than 1,000 staff. These figures vary between documents: the number of beds actually open depends on available staff. Its care areas include emergency, intensive and coronary care, maternity, operating theatre, radiology and interventional radiology, haemodialysis, paediatrics and rehabilitation. The hospital reports around 30,000 admissions and 2,000 births a year, and a CAP-accredited laboratory, the whole being certified by CMS. Telephone: (671) 647-2330.

After Typhoon Mawar in May 2023, the hospital authority described Guam as the site of the worst typhoon in 22 years and mentioned a shortage of available beds linked to the number of patients, with reinforcement from temporary medical staff of the national disaster management system. This experience is a reminder that a major weather event can saturate the supply of care; see the page living in Guam.

In an emergency, the number to dial is 911 throughout US territory. France Diplomatie indicates that the ambulance is the only transport that gives priority on arrival at the hospital, that admission depends on a financial guarantee and that, without cover, access to care can be refused, even when life is at risk. Guam Homeland Security press releases also mention the 988 line (help in case of psychological crisis or suicidal thoughts), available 24 hours a day.

France Diplomatie describes the medical infrastructure of the United States as excellent but at a very high cost and deems an assistance or insurance contract covering all medical costs, including surgery and hospitalisation, as well as medical repatriation, essential: the embassy can under no circumstances cover these costs. See repatriation and assistance and expat health insurance.

The CDC (traveller page for Guam) recommends vaccines against hepatitis A for unvaccinated travellers from one year old, against hepatitis B for all ages, against typhoid for most travellers, and full vaccination against measles (MMR) for all international travellers. The yellow fever vaccine is not recommended. Rabies is uncommon in dogs in Guam, but post-exposure treatment may only be available in large facilities. France Diplomatie reminds travellers that the vaccinations of the French schedule must be up to date, notably diphtheria, tetanus, poliomyelitis, whooping cough and measles.

Dengue is transmitted by mosquito bite and has no curative treatment, according to France Diplomatie, which advises avoiding anti-inflammatory drugs; prevention relies on protection against bites. France Diplomatie mentions the possibility of a vaccine during an epidemic or a long stay in an endemic area, whereas the CDC page on Guam recommends none. In Guam, the CDC documented in September 2019 the first locally acquired case since 1944: of 249 suspected cases, 17 were confirmed, of which 13 were locally acquired and 4 travel-related; the CDC noted that Guam records imported cases almost every year.