America has some of the most advanced medical capabilities anywhere in the world, but access to the techniques and resources necessary to enhance and even extend your life becomes difficult without proper medical coverage.
The Need For Insurance
Developing and maintaining medical technology, and the people in positions to administer the treatment associated with those advancements, carries a significant cost. Very few people have the cash resources available to pay out of pocket for medical care, especially when complicated or extensive care is required.
Health insurance plans provide a means to obtain necessary services without paying all of the costs yourself. Without coverage, only those services absolutely necessary to keep you alive will be provided, and you may find yourself burdened with an overwhelming debt.
Individual vs. Group Coverage
Many companies choose to provide group health insurance to workers as a benefit of employment. The cost of coverage in a group plan is usually shared with the employer, and benefits often tend to be more comprehensive than those found in individually purchased plans.
However, employers are not obligated to offer medical benefits to workers. People without access to employer-sponsored coverage may purchase plans individually, but are also entirely responsible for the premium.
Underwriting
Nearly every state in America allows health insurance companies to medically underwrite the cost of medical plans. The price for your coverage is determined after the carrier completes a risk analysis that includes an examination of your prior treatment history, current health status, and an estimation of your future medical needs.
If the carrier’s underwriters believe you present a higher risk, the cost for your policy will be increased proportionately.
Common Policy Types
Managed care health insurance policies represent the largest and most common plan types in America. The most common managed care programs are health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs.
These plans work around a network care concept, wherein the cost of services has been negotiated with physicians. Out-of-pocket expenses for medical treatment are lower when that treatment is rendered by a participating provider. Services received from doctors outside the network are covered at a lower percentage, and in some cases not at all.
The managed care concept essentially allows the insurance companies to determine the appropriate rate for various medical services.
Government-Sponsored Plans
In America, both state and federally managed health care programs provide millions of people with access to medical services. Medicare provides retirees with benefits that pay for the majority of medical services, but patients must still contribute toward the cost of care.
Medicaid provides health benefits and insurance coverage to low-income families. Depending on the size of the family and their available financial resources, treatment is paid for in full by Medicaid, or shared proportionately based on income.
References
InsureLane: Health Insurance Explained
U.S. Department of Health & Human Services: Centers for Medicare & Medicaid Services: Overview
Medicare.gov: Medicare Benefits
Resources (Further Reading)
NAHU: Consumer Information Guides
NeuroSurgical.com: The History of Health Insurance in the United States
This article is a Twisted Nonsense Exclusive! (02/01/2011)
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