What is Health Insurance in the US (United States)?
Health insurance (Private or Federal insurance) covers the medical expenses of health care treatments of patients, provided by the doctor or provider. Some health insurance plans also cover prescription drugs. An insurance company is also known as an insurer or health plan, and it is an organization contracted with patients to pay for their health care expenses.
Do you need health insurance in the US (United States)?
Medical expenses in the US (United States) are really too expensive, depending on the type of treatment taken. Most people cannot afford to spend so many dollars on their healthcare when they become ill or injured. So, to get rid of this risk, it is very important that you have health insurance in the US (United States) to cover your medical costs from a Health Insurance Company.
How can I get health insurance in the US (United States)?
You can get health insurance in the US (United States) as follows:
- By group health insurance coverage through your job or a family member’s job.
- If you lose your job, then continue the health insurance coverage from your former employer as per the Consolidated Omnibus Budget Reconciliation Act (COBRA).
- As per the ACA act, health insurance in all states of the US (United States) must offer coverage to both adults and their dependents (until 26 years old) to remain on their Family (parents’) insurance plan.
- By buying health insurance directly from the insurance company.
- Federal insurance programs such as Medicare, Medicaid, and SCHIP.
- Tricare for the Department of Defense (DOD).
What is COBRA in the US (United States)?
The Consolidated Omnibus Budget Reconciliation Act (COBRA), which was passed in 1986, provides health insurance coverage to an individual and their dependents after becoming unemployed either vo, either voluntary or involuntary job loss, transition between jobs, death, or divorce. It typically lasts up to 18 months after becoming unemployed and, under certain conditions, extends up to 36 months.
What is the Affordable Care Act in the US (United States)?
Some of the important rules of the Affordable Care Act are as follows:
- States must ensure the availability of health insurance for individual children who did not have coverage through their families.
- Health Insurance must provide Essential health benefits.
- An insurance company can’t decline health insurance coverage due to a patient's pre-existing condition.
- Lifetime coverage and annual limits on essential benefits are eradicated.
- Adults or dependents (until the age of 26) can stay on their family’s health insurance.
- Health Insurance Company will be banned if it drops a policyholder when they become ill.
- Four tiers of coverage: (A) Bronze, (B) Silver, (C) Gold, and (D) Platinum.
What are the types of Health insurance in the US (United States)?
- Federal insurances:
- Medicare
- Medicaid and CHIP
- Tricare for Defense
- Private or commercial insurance:
Some of the national brands are as follows: Anthem Blue Cross and Blue Shield, Aetna, Cigna, Humana, United Healthcare, and Kaiser etc.
What are the types of Health insurance plans in the US (United States)?
- Traditional and
- Managed Care Plan:
- HMO
- PPO
- EPO
- POS
These health insurance plans are organized by the tiers of Coverage in the US (United States): (A) Bronze, (B) Silver, (C) Gold, and (D) Platinum.
| Health Insurance Plan Levels | Insurance pays | Insured pays | Price tag |
|---|---|---|---|
| Bronze | 60 Percent | 40 Percent | Low |
| Silver | 70 Percent | 30 Percent | Medium |
| Gold | 80 Percent | 20 Percent | High |
| Platinum | 90 Percent | 10 Percent | Highest |
Let us see the characteristics of Managed Care Plans:
HMO:
- Individual Policy
- Referral is a must
- Out-of-network providers are not encouraged.
POS:
- Individual Policy
- Referral is a must
- Out-of-network providers are not encouraged.
PPO:
- Group Policy
- Referral not needed
- Out-of-network providers are encouraged.
EPO:
- Group Policy
- Referral not needed
- Out-of-network providers are not encouraged.
How to choose a correct health insurance plan in the US (United States)?
You need to ask a lot of questions before choosing a health insurance plan. The important 3 questions are as follows:
- Where can I receive health care?
As per the plan, can we go to any provider (In-network or out-of-network provider)?
A provider may be a doctor, nurse, dentist, or hospital that provides health care services to a patient to improve their health condition.
Because some health insurance companies won’t pay, or they might cover only the smaller portion as per the patient's plan, when the patient gets health care services from- out-of-network provider. So it’s better to check before choosing the health insurance.
- What does my health insurance plan cover?
Does my plan cover the following services: Vision, dentist, specialist, pregnancy, psychiatric care, physical therapy, home care, nursing care, prescription drugs, laboratory, emergency, hospitalization, preventive care services, etc..
- How much does my health insurance cost?
Premium: The premium is paid periodically by the patient to keep the health insurance plan active.
Out-of-pocket costs: The patient’s share of the cost when receiving health care services directly from the provider. This can include copays, coinsurance deductibles.
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