As a form of insurance, health insurance helps cover the medical and surgical costs of an insured person.
When insurers talk about “providers”, they refer to clinics, hospitals, doctors, laboratories, healthcare practitioners, and pharmacies that provide treatment.
Health insurance coverage is provided to the policyholder or to the person covered by the policy.
This article explains what health insurance is and why it is important, the types of plans, and the laws that govern it.
How do you get health insurance?
The insured may pay out-of-pocket for services and receive reimbursement directly from the insurer, or the insurer may pay the provider directly.
Health insurance is typically included in employer benefit packages in countries that lack universal healthcare coverage, like the United States.
The number of people without health insurance dropped by over 20 million in the years following the introduction of the Affordable Care Act in 2010, according to the Kaiser Family Foundation (KFF).
In 2019, there are 24.9 million uninsured adults, up from 26.7 million in 2016. However, in 2017, the number of uninsured adults rose by 2.2 million to 28.9 million. In the past two years, there was an increase of 10.9% in the percentage of people without health insurance. In spite of this, people with health insurance are still over twice as likely as they were before the Affordable Care Act was implemented.
One-quarter of U.S. citizens of working age do not have health insurance, according to a 2012 report from the Commonwealth Fund. Unemployment or changing jobs was the leading cause of health insurance loss among people in the survey.
According to the KFF, those with low income and African-Americans have a higher likelihood of being uninsured than other groups.
People with different types of health insurance receive different levels of treatment in emergency departments.
Health insurance generally comes in two types: private and public. Additionally, there are a few more specialized types. In the following sections, we will examine each of them in greater detail.
Insurance: private health plans
Health insurance is a major component of the U.S. healthcare system, according to the Centers for Disease Control and Prevention (CDC). National Health Interview Survey researchers concluded that 63.7% of people under 65 years of age in the U.S. have private health insurance coverage.
Government-sponsored coverage is also available.
A health insurance plan such as this provides subsidized healthcare in exchange for a premium. Health insurance provided by the government includes Medicare, Medicaid, the Veterans Health Administration, and the Indian Health Service.
An insurer can also be defined by how it links up with providers and administers its plans. The following are examples of insurance plans.
Managed care plans
If we discuss about top 5 health insurance companies in Arizona and their services. They can offer its policyholders lower cost medical care. Clinics and hospitals outside the network will be penalized and charged additional fees, but they will be able to provide some services.
As the policy becomes more expensive, it becomes more flexible with hospitals.
Plans that offer indemnification become more flexible as the prices rise.
The insured may choose their preferred provider from among all those covered by a Fee-for-Service plan. An indemnity plan typically pays 80% of costs, with the remaining 20% paid by the individual.
HMO plans are health maintenance organizations.
Insured patients are treated directly by these companies. In most policies, the primary care provider coordinates all necessary care.
Plans offered by Health Maintenance Organizations (HMOs) are usually limited to treatments referred by a family physician, and their fees are negotiated to minimize costs. The cheapest of these plans is usually this one.
PPOs are preferred providers.
In that it allows the insured to see any doctor they choose, the Preferred Provider Organization (PPO) is similar to an indemnity plan. The PPO plan also has negotiated costs with a network of approved providers.
Treatment provided by out-of-network providers will cost less for the insurer. A PPO plan, however, allows people to refer themselves directly to specialists and does not require a primary care physician.
The PPO technology did not exist during the 1990’s.
PPO and HMO plans are combined into a Point-of-Service plan. The insured may choose to coordinate all treatment through a primary care physician, to receive treatment from within the insurance company’s provider network, or to seek treatment outside of the provider network. Their choice will determine their treatment progress.
What are the benefits of having a specific type of insurance plan?
How someone plans to receive treatment and how much money they will be expected to pay on the day of receiving it will be determined by their type of plan.
During the 2003 legislative session, the federal government introduced a new account type: the Health Savings Account (HSA). There are HMO plans, PPO plans, indemnity plans, and tax-advantaged savings accounts in this package. The policyholder, however, must combine this type with a health plan that has a deductible over $1,400 for an individual or $2,800 for a family in plan year 2020.
In addition to existing medical insurance plans, HSAs provide coverage for a broader range of treatments. Tax-free contributions to an HSA are made by employers on behalf of their employees. HSAs allow individuals to save money while they are healthy and then use the money in the event of poor health later in life.
People with chronic health problems, such as diabetes, might not be able to save a large amount of money in their HSAs because their health care costs are high.
Despite the lower premiums, these plans are usually linked to high deductibles, meaning that people must pay for all medical procedures and treatment even if the premiums are lower.
The types of plans are increasingly overlapping. It is becoming increasingly difficult to differentiate between various policy types.
Managed care techniques are used by most indemnity plans in order to control costs and make sure there is adequate funding to pay for medically necessary care. Similar to managed care plans, many pay-for-service plans have adopted some characteristics of their own.