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Health Insurance in the United States: General Information


Health Insurance in the United States

It is not a secret that healthcare in the United States of America is very high-quality and high-tech, but at the same time very expensive.

Not every American is able to pay for treatment at full cost without significant damage to the family budget, especially if we are talking about a serious or chronic disease.

Historically, every citizen of the USA must take care of his own health, and there is no compulsory medical insurance in the country, nor is there a duty of doctors to treat you for free, except in emergency cases.

If a citizen has a good job and a stable income, he is able to buy (receive from the employer) medical insurance and undergo the necessary treatment without anxiety that tomorrow he will receive a pack of impressive medical bills. Most Americans have private health insurance, usually sponsored by an employer, or participate in various public programs, such as Medicaid or Medicare.

However, some US residents are left without health insurance because of financial problems or the presence of serious diseases that existed even before applying for insurance — these are the so-called pre-existing conditions.

The current situation in the US healthcare sector has been brought about by the difficult situation with providing the population with medical insurance, aggravated by the economic crisis. The share of Americans protected by health insurance has steadily decreased since at least the mid-1990s.

As of 2010, only 84% of US residents had any form of health insurance.

This means that millions of people at least part of the year lived without insurance and confidence in the future.

Due to the crisis and the rise in unemployment caused by it, more and more people began to apply for state insurance for the needy. Today, public insurance programs cover more than a third of the US population and account for almost half of the country’s health care costs. Public insurance covers mainly vulnerable categories of the population who are unable to purchase private insurance.

Types of US social health insurance

Medicine in the US is private; nevertheless, substantial money is allocated from the federal budget into two large-scale social programs. The Medicaid health insurance system provides medical services to poor Americans. The program was adopted in 1965. With the assistance of Obama, Medicaid has significantly expanded its capabilities since 2010. Expenditures of the federal budget reach 40%. Part of the cost is delegated to state budgets. In addition, the program provides funds to nursing homes for the provision of medical care to low-income families.

To participate in this program, the applicant must document their low income. Starting in 2014, income should not exceed 133% of the country’s poverty level. Medical services under the Medicaid program include specialist advice, hospitalization, prescription drugs, vaccination, preventive care for young children, and, if necessary, long-term care for the sick.

The second US social health insurance program is Medicare. This program is designed for people over 65 years old. About 90% of participants have other medical policies. For example, insurance from the employer. Medicare has several pricing plans. One of them allows you to receive prescription medications at discounted prices. In the second, the range of services provided is much broader.

Despite the high level of medical services, the United States ranks only 72nd in the world in terms of public health.

Another socially significant program SCHIP provides medical care for children from families whose material wealth does not allow them to become members of the Medicaid but is not sufficient for private medical insurance to purchase VMI. The program, partly funded by the federal center, part of the funds allocated from the state budget. The state authorities determine the list of services that can be provided to the child themselves, but there is a mandatory minimum. It includes:

  • hospitalization;
  • dentistry;
  • laboratory research;
  • immunization;
  • preventive medical examination;
  • radiation diagnosis.

Regretfully, many children in the USA lack health coverage despite the existence of the SCHIP program, according to the University of Hawaii Social Science Research Institute. In connection with this, there are various projects that are designed to help such children get the necessary medical services. One of such projects is The Hawai`i Uninsured Project. Which enrolls over 8o,000 children who are not in a public institution nor certified blind or disabled.

Benefits of this program include:

  • emergency care;
  • regular medical check-ups;
  • prescription drugs from Trusted Tablets;
  • immunizations;
  • mental health services;
  • vision and dental care;
  • physician visits.

Private medical insurance in the USA

The Affordable Care Act dated 01/01/2014 requires employers with 50 or more employees to provide them with medical insurance. Otherwise, you will have to pay an additional $2,000 in tax. Moreover, in some cases, the employer pays in whole or in part a medical insurance policy for family members of an employee.
Most US educational institutions strongly recommend their students to become participants in the programs sponsored by them, educational institutions. In case of refusal, they offer to present the existing similar medical insurance.

For those who have lost a steady source of income, there is a COBRA plan on the health insurance market, which provides access to the health care system, due to the circumstances.

The act of accessible medical care allows you to solve the problem of obtaining a medical policy if you already have serious diseases. The client must confirm the absence of the policy for a period of more than six months and provide reliable waivers of the services of private insurance companies.

What are insurance plans and how much does it cost?

Depending on the percentage of medical expenses covered, there are five basic insurance plans:

  • platinum – about 90% paid by the insurance company;
  • gold – the insurance company pays about 80%;
  • silver – the insurance company pays about 70%;
  • bronze – the insurance company pays about 60%;
  • minimal insurance – designed only for emergency cases and is available exclusively to persons under 30 years of age or to those who can confirm that they are in a difficult financial situation.

Insurance plans differ in a number of important points, like: co-pay (a fixed amount you pay for each medical service, and the balance is covered by the insurance company), deductible (the amount you need to spend before the insurance coverage), co-insurance (you pay a certain percentage of the cost, the rest is paid by the insurance company), out-of-pocket maximum (the maximum amount spent during the year you start to receive 100% coverage from the insurance company).

So, the cost of insurance will largely depend on your income, the region and the selected insurance plan. To calculate your insurance cost, use the Shop and Compare Tool calculator on the Covered California official website.

Category: General

Tags: health, health professions, healthcare, healthcare system, insurance