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US Health Insurance

What Is Health Insurance?
Health insurance is a type of insurance coverage that typically pays for medical, surgical, prescription drug and sometimes dental expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly. It is often included in employer benefit packages as a means of enticing quality employees, with premiums partially covered by the employer but often also deducted from employee paychecks. The cost of health insurance premiums is deductible to the payer, and the benefits received are tax-free, with certain exceptions for Corporation Employees. It’s the law under the Affordable Care Act, you may pay a penalty if you don’t have a qualified health care coverage.
 
How U.S. Health Insurance Works
Health care within the U.S. are often very expensive. one doctor’s office visit may cost several hundred dollars and an average three-day hospital stay can run tens of thousands of dollars (or even more) counting on the sort of care provided. Most of us couldn’t afford to pay such large sums if we get sick, especially since we don’t know when we might become ill or injured or what proportion care we’d need. health insurance offers how to scale back such costs to more reasonable amounts.
 
Insurer and Policy holder
An entity which provides insurance is known as an Insurer. A person or entity who buys insurance is known as an insured or as a Policy holder.
The way it typically works is that the buyer (you) pays an up front premium to a insurance company and that payment allows you to share “risk” with many people (enrollees) who are making similar payments. Since most of the people are healthy most of the time, the premium dollars paid to the insurance firm are often used to cover the expenses of the (relatively) small number of enrollees who get sick or are injured. Insurance companies, as you can imagine, have studied risk extensively, and their goal is to gather enough premium to cover medical costs of the enrollees. There are many, many various sorts of insurance plans in the U.S. and many different rules and arrangements regarding care.
 
Important questions you should ask when making a decision about the health insurance that will work best for you:
 
Where can I receive care?
One way that health insurance plans control their costs is to influence access to providers. Providers include physicians, hospitals, laboratories, pharmacies, and other entities. Many insurance companies contract with a specified network of providers that has agreed to provide services to plan enrollees at more favorable pricing.
 
If a provider isn’t in a plan’s network, the insurance firm might not pay for the service(s) provided or may pay a smaller portion than it would for in-network care. this means the enrollee who goes outside of the network for care could also be required to pay a way higher share of the cost. this is often a crucial concept to know, especially if you’re not originally from the local.
 
What does the plan cover?
One of the items health care reform has done in the U.S. (under the Affordable Care Act) is to introduce more standardization to insurance plan benefits. Before such standardization, the advantages offered varied drastically from plan to plan. for instance , some plans covered prescriptions, others didn’t. Now, plans within the U.S. are required to offer variety of “essential health benefits” which include following;
Emergency services
Hospitalization
Laboratory tests
Maternity and newborn care
Mental health and substance-abuse treatment
Outpatient care (doctors and other services you receive outside of a hospital)
Pediatric services, including dental and vision care
Prescription drugs
Preventive services (e.g., some immunizations) and management of chronic diseases
Rehabilitation services
For our international population of scholars who could be considering coverage through a non U.S. based plan, asking the question, “what does the plan cover” is extremely important.
 
How much will it cost?
Understanding what coverage costs is actually quite complicated. In our overview, we talked about paying a premium to enroll during a plan. this is an up front cost that’s transparent to you (i.e., you recognize how much you pay).
 
Unfortunately, for many plans, this is often not the only cost related to the care you receive. there’s also typically cost once you access care. Such cost is captured as deductibles, coinsurance, and/or copays (see definitions below) and represents the share you pay out of your own pocket once you receive care. As a general rule of thumb, the more 
you pay in premium up front. The less you pay in premium, the more you’ll pay once you access care.
 
What Is Affordable Care Act
Under the ACA, Americans were required to carry medical insurance that meets federally designated minimum standards or face a tax penalty, but Congress removed that penalty in Dec. 2017. A Supreme Court ruling in 2012 struck down an
 ACA provision that required states to expand Medicaid eligibility as a condition for receiving federal Medicaid funding, and a number of states chose to refuse expansion. It also allows children to remain on their parents’ insurance plan until age 26. These changes, among others, have led to a drop in the number of people enrolled through the ACA marketplace from a peak of 17.4 million in 2015, to 13.8 million in 2018. The law includes a list of health-related provisions intended to extend health-insurance coverage to millions of uninsured Americans.
 
What are Medicare and Medicaid?
Medicare and Medicaid are two government programs that provide medical and other health-related services to specific individuals in the United States. Medicaid is a social welfare or social protection program, while Medicare is a social insurance program.
 
What is Medicaid?
Medicaid is a means tested health and medical services program for low income households with few resources. Individuals must meet certain criteria to qualify. These criteria vary between states.
Federal authorities primarily oversee Medicaid, but each state is responsible for: establishing eligibility standards deciding service type, amount, duration, and scope setting rate of payment for services
administering the program.
 
What is Medicare?
Medicare is a federal health insurance program that funds hospital and medical care for older people in the U.S. Some people with disabilities also benefit from Medicare.
 
The program consists of:
Part A is hospital insurance. [covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.]
Part B is medical insurance. [covers certain doctors’ services, outpatient care, medical supplies, and preventive services.]
Part C Medical Advantage Plans are a private insurance option for covering hospital and medical costs. 
Part D covers prescription medications. [prescription drug coverage]
 
Network:
A network is a group of healthcare providers that have contracted with insurance companies to offer discounted services.
HMOs and PPOs are both types of managed care, which is a way for insurers to help control costs.
HMO stands for “health maintenance organization,” and the coverage restricts patients to a particular group of physicians called a “network.”
PPO is short for “preferred provider organization” and allows patients to choose any physician they wish, either inside or outside of their network.
 
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