Health Insurance in US

What is Health Insurance in US (United States)?

Health insurance (Private or Federal insurances) covers the medical expenses of health care treatments of patients, provided by the doctor or provider. Some health insurance plans also covers the prescription drugs. Insurance company is also known as insurer or health plan and it is an organization contracted with patient to pay for his health care expenses.

Do you need health insurance in US (United States)?

Medical expenses in US (United States) are really too expensive depending on the type of treatment taken. Most of the people cannot afford to spend so many dollars for their healthcare when they become ill or injured. So to get rid of this risk, it is very important you to have health insurance in US (United States) to cover your medical costs from Health Insurance Company.

How can I get health insurance in US (United States)?

You can get health insurance in US (United States) as follows:

  • By group health insurance coverage through your job or family member’s job.
  • If you lose your job, then continuing the health insurance coverage from your former employer as per the Consolidated Omnibus Budget Reconciliation Act (COBRA).
  • As per ACA act, health insurance in all states of US (United States) must offer coverage to both adults and their dependents (until 26 years of old) to remain on their Family (Parent’s) insurance plan.
  • By buying health insurance directly from the insurance company .
  • Federal insurances programs such as Medicare, Medicaid and SCHIP.
  • Tricare for Department of Defense (DOD).
What is COBRA in US (United States)?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) which was passed in 1986, which gives health insurance coverage available to an individual and their dependents after becoming unemployed 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 extend up to 36 months.

 

What is Affordable Care Act in US (United States)?

Some of the important rules of Affordable Care Act are as follows:

  • States must ensure the availability of health insurance for individual children who did not have coverage via their families.
  • Health Insurance must provide an Essential health benefits.
  • Insurance company can’t decline health insurance coverage due to patient 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 they drop the policy holder when they become ill.
  • Four tiers of coverage: (A) Bronze, (B) Silver, (C) Gold and (D) Platinum.
What are the types of Health insurances in US (United States)?
  1. Federal insurances:
  • Medicare
  • Medicaid and CHIP
  • Tricare for defense
  1. Private or commercial insurances:

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 US (United States)?
  1. Traditional and
  2. Managed Care Plan:
  • HMO
  • PPO
  • EPO
  • POS

These health insurance plans are organized by the tiers of Coverage in US (United States): (A) Bronze, (B) Silver, (C) Gold and (D) Platinum.

Health Insurance plan LevelsInsurance paysInsured paysPrice tag
Bronze60 Percent40 PercentLow
Silver70 Percent30 PercentMedium
Gold80 Percent20 PercentHigh
Platinum90 Percent10 PercentHighest

Let us see the characteristics of Managed Care Plans:

HMO:

  • Individual Policy
  • Referral is a must
  • Out of network providers not encouraged.

POS:

  • Individual Policy
  • Referral is a must
  • Out of network providers 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 US (United States)?

You need to ask a lot of questions before choosing a health insurance plan. The important 3 questions are as follows:

  1. Where can I receive a health care?

As per the plan can we go to any provider (In-network or out-of-network provider)?

Provider may be a doctor, nurse, dentist or hospital that provides health care services to a patient to improve health condition.

Because some health insurance company won’t pay or it might cover only the smaller portion as per the patient plan when the patient gets health care services with out-of- network provider. So it’s better to check before choosing the health insurances.

  1. What does my health insurance plan covers?

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.,.

  1. How much does my health insurance cost?

Premium: Amount paid periodically by patient to keep the health insurance plan active.

Out of pocket costs:  The patient’s share portion of the cost when receives health care services directly to the provider. This can include copay, coinsurance, and deductible.

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