Health Insurance

There are many different forms of health insurance in the United States, most of them costing the user large amounts of money. The United States is the only major developed country that does not provide health care to its citizens. Recent events in the United States government indicate that health insurance programs will be changing in the near future, but there is no clear indication of what form those changes will take. At present, some of the types of health insurance are the Affordable Care Act plans, Medicare Health Insurance, Supplemental Health Insurance, and AARP Health Insurance. This article will give a quick synopsis of each of these types of plans, their similarities, and their main differences.
The Affordable Care Act (also known as Obamacare) is a collection of different insurance plans to suit different income levels, health care requirements, and family size. Each individual or family is required to calculate their own projected needs for health insurance each year, use a mathematical formula to calculate their MAGI (Modified Gross Adjusted Income) for the coming year, determine if their income level qualifies them for any if the cost assistance programs available, estimate to the best of their ability how much in total they can afford to spend on insurance premiums, deductibles, copays, and other expenses, and from that choose a plan that works for them. The process is complicated, time consuming, stress-inducing, and difficult to navigate through, but for most people in the target income levels, health insurance can be arranged for a relatively low cost – the plan website quotes premiums of $50 to $100 per month. You must keep in mind, though, that since the insurance companies are in it to make a profit, all of the money that they pay out for health care must be less than the amount they take in in premiums. Plans differ by state, as do coverage amounts, premiums, copays, and networks. The ACA allowed nearly twenty million people to access health insurance who were not previously able to afford it.
Medicaid Health Insurance is the medical plan signed onto law by the Federal Government in 1965. It provides health insurance to low-income Americans who could not otherwise afford to access health care at all. The program underwent a massive reform and expansion in 2014, and now covers over 80 million people in the country. Those who qualify for coverage under the Medicaid plan are senior citizens, people with disabilities, children, and low-income working parents. The program costs users much less than other forms of health insurance, thereby allowing more people to access needed medical care. Medicaid covers those with chronic conditions, as well, which some insurance plans do not do. The Children’s Health Insurance Program, or CHIP, is in some areas a division of Medicaid and in other areas a stand-alone program, that provides children of families who make too much money to qualify for Medicaid with health insurance, as well as the parents. CHIP also covers pregnant women, to ensure that they receive adequate prenatal care. This improves the outcomes of pregnancies all over the country. As with the ACA, while Medicaid and CHIP are jointly funded by the federal government and the states, and, while the basic rules concerning who must be covered are set out by the federal government, each state has its own set of rules and regulations superimposed on the basic plan provided by the federal government, making the actual delivery of Medicaid and CHIP slightly different in each state.
While most people under the age of 65 can find adequate coverage through one of the available programs, there are situations where an extra health care policy can be beneficial. Supplemental Health Insurance plans are extra insurance plans separate from the ACA (also known as Obamacare) or Medicare or Medicaid or CHIP which are available to purchase for those who wish to add to their existing health care plan. These plans are sold by private insurance companies, so there are a lot of them to choose from, but they are regulated under different rules than either the ACA or Medicaid and it is important to understand the differences before making a purchase. These plans serve to fill in the gaps left in ACA plans or Medicare, giving the plan holder help with co-pays, deductibles, and co-insurance. They can be a big help by reducing these expenses and helping to pay for prescription drugs as well. Some of the available supplemental plans cover dental expenses, while others cover vision care expenses, and some cover both. This can be a great help for a family, since dental care for a whole family can be extremely expensive, as can eyewear for several people. Supplemental plans, as with all insurance plans, need to be looked at closely before purchasing them, to make sure that they will provide good value for the money. Some plans only cover you when you are within a certain area, so if you plan to leave home you will need to look at buying traveler’s insurance. For those over age 65 on Medicare, a supplemental plan can be highly beneficial. Some of the available supplemental insurance plans for Medicare include Medicare Advantage, Medicare Part C with Drug Coverage, Medicare Part D Prescription Drug Coverage, and Medigap. These programs can make a huge difference to someone on a fixed income, making prescription drugs affordable and filling in the gaps in Medicaid so that far less must be paid out of pocket by the senior citizen.
The American Association of Retired Persons, or AARP, is a huge organization, part of it non-profit and part of it for-profit, originally formed with the idea of being dedicated to bettering the lives of people as they age. They provide help for people over age 50 in various ways all across the country. The organization has many different branches, including the AARP Insurance Plan. This is a system by which private insurance companies are allowed to use the AARP name to sell insurance policies to its members, and the private insurance companies pay the AARP for the privilege. Critics of the program say that in some cases, inferior policies are sold to AARP members for exorbitant prices, and include coverage that is far less than what the policy holder could have gotten for the same price from an insurance policy not affiliated with the AARP. The reputation of the AARP is such that people will assume they are getting a good deal simply because the policy carries the AARP logo. The Medigap policies “sold” by the AARP are a lucrative business for the organization.
People who are between the ages of 50 and 65 and who are not covered by an employer health plan, often have a great deal of trouble getting and keeping medical coverage at all. Most insurance companies are not willing to provide insurance to those who already have existing health problems, and age 50 seems to be where a lot of peoples’ health issues seem to become worse. This makes this age group expensive to provide health care to, and therefore reduces the insurance company’s profits. This means that many people between the ages of 50 and 65 are left without health insurance at what may be the most vulnerable time of their lives because the insurance companies cannot see a way to make a profit from them, and therefore will not sell them health insurance plans at all. The ACA went a long way towards correcting that deficiency, but the program still has gaps for some people. The AARP plans can provide the additional coverage needed to fill in those gaps and give people in that age group full, secure coverage. As with any insurance plan, though, it is imperative that any prospective buyer read the plan carefully and do the homework required to make sure that the coverage you are paying for is adequate. There have been reports of policies being sold to AARP members that pay only $1000 for a procedure that costs several times that much, and there is no cap on how much the policy holder is required to pay out of pocket. These types of clauses are the ones that a prospective buyer should be looking carefully for – a policy with a clause like that is most certainly not worth the money.
In conclusion, health insurance in the United States is a huge, complex system that is far more expensive than is warranted by the outcomes it produces, and far less efficient than its high costs would suggest. The introduction of the ACA was intended to improve outcomes, which it may have done due to increased coverage of those who previously could not afford health care at all, and reduce prices, which it has not proven to do in any significant way. The ideal solution for medical care in any country appears at this time to be universal, or single-payer health insurance. Of all the systems that have been developed worldwide, that seems to be the one that provides the best outcomes for the lowest prices. The most efficient and successful healthcare system in the world according to the World Health Organization is France, with the United States coming in at number 37 on the list, even though the US spends more than twice as much money per capita. Perhaps it is time for the US to look more closely at universal health care.