Health Insurance in the United States
Health insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses. Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government.
This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children’s Health Insurance Program. It also includes insurance covering disability or long-term nursing or custodial care needs.
Types of Health Insurance
There are two main types of health insurance:
(A) Private health insurance:- It refers to health insurance plans marketed by the private health insurance industry covering policies obtained through employer- sponsored insurance of Americans receiving insurance provided as a benefit of employment.
(B.) Public or government health insurance:- Public health insurance is a program run by U.S. federal, state or local governments in which people have some or all of their healthcare costs paid by the government. In this type of insurance, the state subsidizes healthcare in exchange for a premium. The two main types of public health insurance are Medicare and Medicaid. Medicare is a federal health insurance program for people aged 65 years or older and people with certain disabilities. Medicaid is a public health insurance program for some individuals and families with a low income or disabilities.
Managed care plans:- In this type of plan, the insurer will have contracts with a network of healthcare providers to give lower-cost medical care to their policyholders.
Indemnity, or fee-for-service plans:- A fee-for-service plan covers treatment equally among all healthcare providers, allowing insurers to choose their preferred place of treatment. The insurer will typically pay for at least 80 percent of costs on an indemnity plan, while the patient pays the remaining costs as a co-insurance.
Health maintenance organizations (HMOs):- These are organizations that provide medical care directly to the insured. The policy will usually have a dedicated primary care physician that will coordinate all necessary care.
HMOs will normally only fund treatment that is referred by this GP and will have negotiated fees for each medical service to minimize costs. This is usually the cheapest type of plan.
Preferred provider organizations (PPOs):- PPO is similar to an indemnity plan, in that they allow the insured to visit any doctor they prefer.The PPO also has a network of approved providers with which they have negotiated costs.
Benefits covered in Health Insurance
The following benefits are covered in Health insurance in USA:
(a.) Outpatient care—the kind you get without being admitted to a hospital.
(b.) Any emergency services such as related to ambulance vans etc.
(c.) Treatment in the hospital for inpatient care given to every individual covered under the insurance.
(d.) Care is also provided to the mothers before and after the birth of babies.
(e.) Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy.