The Healthcare System in American Samoa: Health Insurance, Hospital, Emergencies and Health Risks

There is no universal health insurance fund comparable to French Sécurité sociale in American Samoa. The system combines three tiers. US federal programmes form the first: Medicare, for people aged 65 and over, and federal funding of the territory’s Medicaid. The second is territorial: the American Samoa Medicaid Agency runs the Medicaid programme and the Children’s Health Insurance Program (CHIP), while the territory’s Department of Health offers primary care, dental care and women’s health services. The third consists of employer insurance and individual contracts, supervised by the Insurance Commissioner.

The territory’s Medicaid has existed since 1983. MACPAC indicates that the territories operate with an annual federal funding ceiling (the section 1108 ceiling) instead of unlimited federal funding, and that the 2023 appropriations act permanently set the federal contribution rate at 83% for American Samoa. Medicaid.gov specifies that the territory has no TANF or SSI programme and does not determine eligibility individually: it applies presumptive eligibility, based on the share of the population below 400% of the federal poverty level, estimated each year and approved by CMS. Several tens of thousands of people are considered eligible, and the federal section 1108 ceiling stands in the tens of millions of dollars. Up-to-date data should be requested from the Medicaid Agency.

Medicare is for people aged 65 and over. According to the CMS guide on immigrants’ coverage options, US citizens and qualified immigrants with at least 40 quarters of contributions (10 years) receive Part A, hospital insurance, premium-free. Without enough quarters, Part A can be bought: a reduced monthly premium from 30 quarters, higher below that. Part B (doctors and outpatient care) has a monthly premium and an annual deductible, revised each year; permanent residents must show five years of residence for Part B. Part A has a hospital deductible, also revised each year. CMS refers Medicare questions to 1-800-MEDICARE.

The territory’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 Medicaid Agency (Executive Office Building, room 306, Pago Pago; telephone 684-699-4777; email info@medicaid.as.gov according to CMS). Employer insurance and individual contract: for insurance taken out by oneself or by an employer that operates only in American Samoa, it is the Insurance Commissioner who provides information (Lumana’i Development Building, Tafuna; telephone 684-699-4626, extension 8110). This office publishes notices on the insolvency and cessation of business of local insurers: before taking out a policy, you should check with the Commissioner that the insurer is licensed and operating. Lastly, CMS reminds readers that a resident of the territory cannot use the federal Marketplace.

The territory’s Department of Health (telephone (684) 633-5871, Monday to Friday from 7:30 a.m. to 4 p.m.) presents primary care services covering health promotion, prevention, curative care, rehabilitation and support, dental care (fillings, extractions, root treatments, fluoride varnish, scaling, consultations and prescriptions) and a women’s health service. The official sources consulted describe no uniform organisation of the first-contact doctor nor published consultation fees for a foreigner. 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.

For medicines, no official list or rate was read for the territory. Chronic treatment should be prepared before departure with your regular doctor, and France Diplomatie recommends consulting a doctor or an international vaccination centre well before leaving. 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. The detail of reimbursements by situation is in the page healthcare reimbursement in American Samoa.

The LBJ Tropical Medical Center, in Faga’alu (Ma’oputasi county), is presented on the facility’s page as the only hospital in American Samoa, with 150 beds. The territory’s government expropriated nearly twenty acres in Faga’alu in the 1960s to build it, and the hospital opened on 6 June 1968. It is run by the LBJ Tropical Medical Center Authority. Its page describes an emergency department with doctors on call at all hours, tuberculosis, leprosy and obstetrics units, a renal dialysis unit, maternal and child health programmes, programmes against chronic and communicable diseases and against filariasis, and mental health. The postal address is Pago Pago, American Samoa 96799.

The hospital publishes on its site a downloadable price file of its acts and procedures (Charge Master), and a price transparency page; this page does not deal with the rates applicable to a non-resident. The number of beds and the list of services are those of the presentation page at the date of consultation. As hospital provision rests on a single facility, assistance and medical repatriation take on added importance in the event of a major climatic event or the unavailability of a service; see the page living in American Samoa.

France Diplomatie gives, for the whole of US territory, the emergency number 911; its page does not specify the case of American Samoa, whose local number and emergency arrangements should be confirmed on arrival. France Diplomatie adds that only an ambulance ensures priority on arrival at the emergency department and that admission is subject to a financial guarantee.

France Diplomatie describes the United States’ medical infrastructure as excellent but very costly and deems essential an assistance or insurance contract covering all medical costs, including surgery and hospitalisation, as well as medical repatriation. See repatriation and assistance and expat health insurance.

The CDC (traveller page consulted, level 1 “practice usual precautions”) recommends vaccines against hepatitis A for unvaccinated travellers from one year old, against hepatitis B for all ages, against typhoid for most travellers, and complete measles vaccination (MMR) for all international travellers. It specifies that rabid dogs are not common in the territory, pre-exposure rabies vaccination being a case-by-case decision. France Diplomatie reminds travellers that the vaccinations of the French schedule must be up to date.

Dengue and Zika are classed by the CDC among the diseases not preventable by vaccination, transmitted by mosquito bite: prevention relies on protection against bites, and a pregnant woman infected with Zika can pass the virus to her child. France Diplomatie specifies that dengue has no curative treatment and advises avoiding anti-inflammatory drugs. Recent health notices from the territory can be consulted on the Department of Health site.