The United States of America possesses the world’s highest nominal Gross Domestic Product (GDP). Ironically, it also remains as one of the most expensive countries out there in terms of offering basic human rights to the public. Healthcare, for instance, is quite unaffordable to myriads across different states. While it typically depends on the type of care provided, even visiting a doctor’s office once, or getting admitted in the hospital for a couple of days could lead to you paying your hospital bills in five-digit figures. It is especially true for locals who are unable to acquire such costly medical services despite the availability of Medicare and Medicaid plans and hence often remain untreated.
However, amid such an expensive medical care system, the American health insurance plans help save the day for many people. Health insurance’s primary job is to cover the whole of your medical treatment costs or a certain degree of it.
Every country’s health insurance might differ vastly from one another. This article will make you understand the basic mechanism of the healthcare insurance system in the United States.
WHAT IS THE INSURANCE PLAN INCLUSIVE OF?
Health care reforms in the US had been able to introduce the Affordable Care Act (ACA), where more standardization is incorporated in the health insurance plan for family and individual health coverage purposes. Before the introduction of this act, the benefits vastly differed from one program to another, for instance, covering something even as simple as prescriptions were considered void before the standardization. Now the US calls for offering several essential health benefits, some of which may include:
- Emergency services– for patients who may have to rush to the ER for immediate intensive care for major injuries and illnesses.
- Prescription drugs– as prescribed by the doctor to help you with treatment for any illness that you may have.
- Mental health and drug abuse– treatment for substance abuse and rehabilitation services for mental well-being is also an essential health benefit catered for in insurance plans, mainly due to rising concerns in youngsters.
- Outpatient care– refers to the care, services, and doctor’s advice needed by patients outside the premises of the hospital.
WHERE ARE THE INSURANCE PLANS APPLICABLE?
If you are curious as to where exactly you could receive such kind of medical care and if it is possible for you to attain insurance’s services anywhere in the country, then the answer is not really.
Know that health insurance companies regulate their costs by influencing access to providers. Such providers may include healthcare institutions like hospitals, laboratories, clinics, pharmacies, and more. Insurance companies tend to be in contract with healthcare service providers who are available to offer service plans that cater to essential benefits to consumers at very favorable prices. If you do not exist within the network of the insurance company, chances are your medical costs might not be sponsored, or only a fraction of it is amounted for, relative to those available within the given networks. Simply put, in-network enrollees are prone to receiving higher healthcare monetary assistance, while those who are outside of the network have to bear a higher portion of the cost by themselves.
HOW MUCH DOES IT COST?
As stated above, paying the premium is one of the transparent costs that exist while you enroll in a healthcare insurance plan. It is an upfront cost that you are fully aware about. However, pricing can be a bit complicated, and the premium cost might not be the only cost that you have to incur at the end of the day. When you access care, there are certain forms of expenses that you may have to account for from your own pocket, such as copay, coinsurance, annual deductible, etc. One thing for sure is that the more you will pay upfront with your premium, the less you will have to pay while you actually receive care and vice versa.
HEALTH INSURANCE SPONSORS
In the USA, there are typically three major health service providers or agents, the government that covers just about half the healthcare service’s expenses in the country with the insurance programs it runs. Then comes private health insurers, which are companies typically linked with other firms to cater to their employee’s healthcare services as a form of one of the benefits offered or even individuals subscribing to insurance plans on their own. Lastly, there exist individuals who remain uninsured and choose to self-sponsor their medical expenses and are most likely related to Bill Gates or Warren Buffet.
PAY NOW OR PAY LATER?
To be fair, whether you choose to pay before you receive medical treatment or after, you still have to pay either way. However, it is definitely recommended that you more pay upfront rather than having to pay during your medical service treatment. The reasoning for this is most people who don’t pay upfront tend to delay their treatments and create a barrier between receiving care to avoid costs, which could be fatal. Initial payment is a smarter idea, so you can receive treatment whenever necessary.
FEDERAL HEALTH CARE INSURANCE PLANS
The US federal government reforms had introduced some health insurance plans, the popular among them being, Affordable Care Act (ACA), also known as Obamacare, or Consolidated Omnibus Budget Reconciliation Act (COBRA).
Obamacare originally came into being in order to lower healthcare costs for those who are unable to afford them by requiring everyone to pay a tax penalty or have health insurance, so they do not go with uncompensated care. COBRA mainly focuses on employees and their dependents, attainting continued benefits of healthcare insurance, aimed at workers who lost their jobs or experienced a reduction in their working hours. COBRA requires you to continue with the same health insurance provider and plan that you already have while Obamacare would need you to scrap your old plan and choose a new healthcare insurance plan, from the many available.
THE CONCLUDING REMARKS
While there may be a ton of healthcare insurance programs that exist in the country, you would definitely need to dig a little deeper where you can choose from private and government-based insurance plans that differ vastly in terms of pricing and benefits. Healthcare insurance plans also exist for specialized groups such as militants, veterans, children, the elderly, and immigrants.