Health Insurance in the United States just like every other jurisdiction is any insurance policy to help pay for medical expenses. In the United States, this may be through private insurance, social insurance or a government social welfare program. Furthermore, the words “health coverage”, “health care coverage”, and “health benefits” are interchangeably in use with health insurance coverage in the United States.
Similarly, the term “health insurance” is also mean any form of insurance policy which provides insurance protection against the costs of medical services of the Policyholder. And these usages include both private insurance policies as well as social insurance programs such as Medicare. Medicare is a sort of program which pools resources from policyholder’s premiums and distributes the financial risks across the entire policyholders to ensure that everyone enjoys insurance coverage. Furthermore, it also includes social welfare programs like Medicaid and the children health insurance program, which are meant to provide protection. And help to people who are incapable of affording health insurance coverage.
Additionally, health insurance policies also offer insurance coverage to cases of disability or long-term nursing or care needs. And different health insurance policies in the United States provide different levels of financial protection and coverage. Therefore, it is imperative for you to check properly what your insurance needs are before buying health insurance plans to ensure that your health needs enjoy proper coverage. This is because about above 40% of policyholders in the United States complain that their insurance plans do not meet their needs.
How US Health System Work
Unlike most part of the world where healthcare facilities are run by governments or by private sector businesses, the US health system has a large share of its hospitals and clinics owned and controlled by private non-profit organizations. Notwithstanding, the United States has the highest health care costs in the world. Although these expenditures are covered largely by public payers such as the Federal, State and local government institutions, they can also be covered by private insurance as well as individual payments.
Similarly, the US health system does not make provision for health care to its overall population. And as such, no single national health insurance system exists, as they predominantly rely on employers who on their own provide health insurance to their employees and other dependents.
However and notwithstanding the above, the US government has programs that attempts at providing coverage for healthcare expenses to the weak components parts of the society as the elderly, disabled and the poor.
United States Health Insurance
Health insurance in the United States is not compulsory for residents and citizens. It is optional, but highly advised and necessary due to the high cost of health services in the US which is more than in any other country in the world.
There are two types of health insurances in the United States and they are the private and public. While some people choose either of the two types, most people choose a combination of both.
United States Public Health Insurance
The United States public health insurances are: Medicare, Medicaid, and Children’s Health Insurance Program.
Medicare
The US Medicare public insurance is a national health insurance program since 1966. It exists to provide health insurance for US citizens who are older than 65 years old, and also to younger people with end- stage renal disease, ALS, and some other disabilities.
The Medicare program is divided into four parts and they are:
Part A
This is the part which provides covers for hospitals, skilled nursing and hospice services and charges.
Part B
This part covers outpatient services, including some providers’ services.
Part C
This serves as an alternative called Managed Medicare. And which permits patients to make choice of health plans with at least the same health insurance coverage as Part A and B, and often, also the benefits of Part D. It equally provides a yearly out of pocket spend limit which are lacking in Part A and B. However, to sign in this part, you must first be a signee in Part A and B.
Part D
Provides covers for mostly self-administered prescription drugs.
Medicaid
This is a US Federal and State insurance program that helps provide coverage to people with limited income and resources to cover medical costs, and also cover benefits usually not covered by Medicare such as nursing home care and personal care services.
The Medicaid represents the largest US source of funding for medical and health services for people with low income.
Children’s Health Insurance Program
This is a US insurance program that provides coverage to children of families with modest income that are not low enough to qualify for Medicaid. It is formerly known as the State Children’s Health Insurance Program (SCHIP),
The Affordable Care Act – Obamacare
Affordable Care Act (ACA) which is Legislation signed into law by President Barack Obama in the month of March 2010. The ACA represents a step towards a comprehensive healthcare reform by President Barack Obama administration in March 2010. The intendment of the ACA is to broaden access of Americans to health insurance plans. Most especially the ones who were yet to get insurance cover.
The coming into effect of the ACA marks the first time in the history of the USA health insurance that women will have a sure access to maternity coverage services which enjoys the protection of the ACA include:
- Services, such as prenatal and postnatal doctor visits, Outpatient gestational diabetes screenings, lab studies, medications, etc.
- Inpatient services, such as hospitalization, physician fees, etc.
- Newborn baby care
- Lactation counselling and breast pump rental and anyone willing to enrol in or change to a different health plan must do this during the Open Enrolment Period, which begins on November 15 every year for coverage starting in the next calendar year.
OTHERS ARE
- Ambulatory patient services
- Breastfeeding
- Emergency services
- Family planning
- Hospitalization
- Laboratory services
- Mental health and substance use disorder services
- Pregnancy, maternity,
- Prescription medications
- Preventive and wellness services and chronic disease management
- Pediatric services
- Rehabilitative and habilitative service
Affordable Care Act as a federal statute signed into law by President Obama in the year 2010 is for the sole aim of extending health insurance coverage to those without it. And makes compulsory for every citizen to have health insurance. The Act subsidies for low-income families, by taxing healthcare providers. And high-income families, as it was designed to lower health care costs while providing better health care for American citizens.
United States Private Health Insurance
Private health insurance providers in the US numbers about a thousand, with each of them selling different insurance plans with different premiums, and which largely depend on a person’s medical history and other associated factors. However, while they offer individual plans providing insurance coverage for only one person, they also offer group plans targeting families in particular.
Usually, there are three types of Private Health Insurances in the United States:
Traditional fee-for-service private health insurance plans:
This is the plan which is usually the most expensive and as such, people with an income lower than the average income in the US find it difficult to purchase them. However, it represents the best insurance plan as they are the most flexible.
Health Maintenance Organizations (HMOs):
This offers a limited choice of healthcare providers, but also offers lower co-payments and mostly covers the costs of more preventative care. They are usually evaluated and accredited by the National Committee for Quality Assurance.
Preferred Provider Organizations (PPOs):
This is just like the HMOs and they offer lower co-payments yet give more flexibility when selecting a provider. This is because they give you a list of providers to make a choice.
United States Health Insurance Requirements for Foreign Visitors
United States health insurance is not compulsory for its shot term visitors, because the Authorities have not made health insurance mandatory for short-term travellers to the country, as B-1/B-2 visa Holders. However, it is highly necessary that a visitor to the US should subscribe to health insurance in case of eventualities. This is because healthcare in the US is very expensive as mere hospital check-up for a simple headache can cost you hundreds of dollars and more serious illness can cost thousands of dollars.
United States Health Insurance Options for Legal Immigrants
Legal Immigrants in the United States are eligible for private health insurance. Additionally, lawful immigrants are also eligible for lower costs on monthly premiums, And lower out-of-pocket costs based on your income, as follows:
Those with annual income of within 400% of the federal poverty level or below may be eligible for premium tax credits and other savings on Marketplace insurance.
And those with annual household income of below 100% federal poverty level that are not otherwise eligible for Medicaid are eligible for premium tax credits. And other savings on Marketplace insurance if they meet all requirements relating to eligibility.
United States Health Insurance Options for Illegal Immigrants
Illegal Immigrants in the US does not get insurance coverage from the US government funded health insurance. However, they can get health coverage only from private providers. Similarly, Community centers can provide medical help to undocumented immigrants in the US. This is called Safety Net Providers, provided that the healthcare seeker can participate in fee- for –service health care.
