How Does Health Insurance Work in The USA

Would you like to know how health insurance works in the USA? Then this guide can be very useful for you. Health insurance is among the most important in the United States. The Federal Government also applies several programs to protect people with lower incomes and these can be combined with insurance plans for greater protection. Read on and find out all the details.

First of all, we must tell you that medical care in the USA is expensive. Likewise, the costs of hospitalization and emergency care increase every year. Without health insurance, it would be difficult for most people to pay their health care bills. Therefore, health insurance is a way for people to:

  • They can protect themselves from the extreme financial costs of medical care if they become seriously ill.
  • Make sure they have access to medical care when they need it.

 

Types of Health Insurance in the USA

Next, we describe the types of health insurance that you can find in the United States:

  • Funded by Taxpayers: That is, a policy financed by federal and state taxes; Some examples are Medicare, Medicaid, Obamacare, and the Children’s Health Insurance Program (CHIP).
  • Private Financing: As its name implies, it is provided primarily through employer-sponsored plans; Some examples are Blue Cross and Blue Shield plans, non-Blue commercial plans, HMOs, and self-funded employer plans.
  • Employee Insurance: What are policies granted through companies and private insurers. Currently, 160 million people are insured through employer-sponsored health insurance.
  • Private Insurance: It is any policy that you buy from an insurance company on your own. Approximately 15 million people in the US purchase health insurance on their own.

 

Examples of Private Health Financing:

  • Blue Cross and Blue Shield health insurance companies
  • Non-blue commercial health insurance companies
  • Self-Funded and Employer-Sponsored Benefit Plans

Important: Private health insurance is funded primarily through benefit plans provided by employers.

 

Examples of Public Health Financing:

  • Health maintenance organizations (HMOs)
  • Medicare
  • Medicaid
  • Obamacare
  • CHIP
  • Health plans for federal/state employees
  • Veterans Health Administration (VHA)

 

What Coverage Do Health Plans Offer in the USA?

Some health plans are supplemented by those offered by the Government within its Medicaid and Medicare programs. Federal Plans cover the following:

  • Hospitalization expenses
  • Emergency and preventive medical care
  • Medication Prescription

 

When combined with private plans, protection is improved at a certain cost. On the other hand, there is a wide variety of medical insurance that protects against all types of illnesses or accidents, except those existing conditions at the time of contracting the policy. In various cases, the pre-existence can be covered, especially when there is a change from one insurer to another.

Health Insurance is generally classified into coverage for accidents and illness policies. Some plans establish annual benefit limits or limits for each specific coverage, but there are also plans without limits.

The simplest policies usually protect against the most serious chronic diseases and frequent ailments. The most complete policies even cover home care until the person’s rehabilitation. Among other covered medical expenses are the necessary medications, diagnostic studies, chemotherapy treatments, radiological, and others. Most insurers cover maternity expenses.

Finally, other medical expenses that may be included are dental plans, both preventive and to solve problems due to illnesses or accidents. There are also exclusive optical protection policies to purchase lenses or glasses.

 

How Do Health Insurance Companies Operate in the United States?

It depends on the insurer. Some operate through reimbursement, others pay directly for the services received by the insured. This depends on whether they use their network of medical services, preferred providers, or if you can go to any doctor or hospital you prefer, including services abroad.

The most comfortable services are where the insurer pays directly to the hospital or doctor, however, it may not be available in all cities depending on the insurer and the network used.

Reimbursement policies require the insured to pay for the services received and then submit the request with the medical bills to obtain the corresponding payment from the insurer.

 

Regulations of Health Plans in the USA

States primarily regulate health insurance by setting standards for when and under what terms a (state-licensed) health insurer must accept an applicant.

Federal laws also regulate health insurance, including ERISA and HIPAA. Next, we describe each of them:

  • ERISA: Employee Retirement Income Security Act of 1974. Establishes national standards for the employer and union-sponsored health plans. In addition, it prohibits states from regulating self-funded employer and union health plans.
  • HIPAA: Health Insurance Portability and Accountability Act. Requires private insurers to accept certain people who drop group coverage in the individual market regardless of health status and without exclusion for pre-existing conditions.

Important: In most states, if eligible individuals (chronically ill, low-income, children) are guaranteed access to coverage in the state’s high-risk group; private insurers are not required to sell you additional coverage.

 

Are the Companies that Sell Medical Insurance Reliable?

Yes, although it is always possible that there is some discrepancy between the insured and the insurance companies, they are usually easily clarified. If the inconvenience persists, you can go to the NAIC, the Consumer Defense, or to the courts in each state.

In our list of health insurance, you can see some of the most reputable insurance companies in the United States.

 

Final Thoughts

Health insurance in the USA helps people pay for medical care. In this way, if you obtain insurance through your employer, you will be able to pay a premium based on the average cost of necessary medical care based on each social group; This translates into small money savings in case you need immediate attention for emergencies or health problems. Therefore, health insurance makes the cost of health care affordable for most people.

 

Read More: 4 Best Health Insurance for Children in the United States