Private health insurance is the main source of health coverage for most Americans. The Centers for Disease Control and Prevention estimate that
Older people, some children, and families from low-income households are more likely to have public health coverage.
Programs include Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP). TRICARE and the Veterans programs also provide some coverage.
A person who is not covered by a publicly funded program, or who has only partial coverage, will need some kind of private health insurance.
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In 2010, 18.4 percent of all people in the United States, or 49.9 million people, had no health insurance.
The 2010 Affordable Care Act, also known as “Obamacare,” brought major reform to the health care system in the U.S.
Early changes affected older people, children, people with pre-existing conditions, and young adults. In 2012, financial assistance was introduced to help those unable to afford insurance.
Young adults over the age of 19 years and under 26 may now remain or be added to their parents’ insurance plan. A person under 19 years of age may need to be part of an open enrollment period, if they want to enroll as an individual.
New government-assistance programs and other provisions ensure that those with pre-existing conditions get coverage. Insurance companies can no longer refuse coverage for people with a pre-existing condition.
The Act aimed to ensure that every American would have medical provision, and it changed the way many people obtained health coverage.
New facilities include Consumer Operated and Oriented Plans (CO-OPs) and online exchanges.
In 2014, a provision called “Promoting Individual Responsibility” came into effect. It meant that most citizens must purchase health insurance, or pay a fee.
According to the Centers for Disease Control and Prevention (CDC), by 2015, the number of people aged 64 years and under without insurance had fallen to
A person whose health care is not covered through an employer, who is not part of a CO-OP, and who is not eligible for a state-funded program, will probably have to buy health insurance as an individual.
When selecting the right insurance option, the purchaser needs to be aware of various factors and to think carefully whether an option is suitable before proceeding with a purchase.
For example, should the plan include prescription coverage or not? Are pre-natal visits likely to be necessary?
Matching individual needs with what is available, deciding on the most appropriate coverage, working out one’s current circumstances and those of the family, may seem confusing and daunting.
The following points need to be considered carefully.
One plan or separate plans
Adding a spouse or offspring to a plan is sometimes, but not always, a good idea.
If both spouses work, and their employer pays the majority of their premium, it may be cheaper than one spouse adding family coverage.
On the other hand, if each partner has individual coverage and an unexpected pregnancy occurs, the baby may not be covered until time for open enrollment and a change to family coverage. This can mean that if a newborn needs care, the insurance may not cover the cost.
Deductibles are a consideration, and whether they are separate or a joint out-of-pocket maximum for the whole family.
It is always important to balance the benefits offered against the sum to be paid out in premiums.
Is my doctor included?
When considering a plan, people should make sure that their doctor or clinic is listed in their network of healthcare professionals. Otherwise, they may either have to change doctors or pay out-of-pocket for the one they prefer.
Choose relevant options
Choosing a plan with only the necessary options can help to keep premium costs to a minimum. For example, if the purchaser or their spouse is a female over 45, maternity coverage will probably not be a priority.
It is worth noting that prescription plan coverage is unlikely to cover all drugs, especially the newer, more expensive ones. Purchasers can ask for a list of preferred drugs that each policy offers to see if their routine medications are on it.
Big premiums today, or in the future?
A person with disposable income, who enjoys good health, might prefer to opt for a high-deductible plan to start with, as this may offer progressively lower monthly premiums with the passing of time.
Someone who currently has high health care requirements may benefit more from a low-deductible plan.
Assistance that is offered due to the Affordable Care Act (ACA) 2010 includes Medicaid and subsidies.
Medicaid
Medicaid has always been available for some eligible low-income candidates. The new legislation made it available to more people. Since 2014, those earning up to 133 percent of the federal poverty level are eligible for Medicaid.
Subsidies
Individuals earning less than 400 percent of the federal poverty level can apply for financial assistance in paying for their insurance premiums through government subsidies.
Since 2014, not-for-profit companies have offered policies under the CO-OP program.
Applying for assistance can be complex. The system takes into account both income and assets.
A person has to go through enrollment to find out what the cost will be, and whether or not it is worth opting in. There is no charge for this process.
The following web pages and directories offer more information about health insurance options:
The Health Insurance Marketplace is where people can find out what they qualify for under the insurance plan. It provides a price comparison for subsidized health insurance.
Health Coverage for All enables people to work out their status and whether they are eligible for support.
U.S. Directory of Health Care Options is a state-by-state guide to helping Americans navigate their public and private health coverage options.
Coverage for All, Bilingual Handout gives information in English and Spanish.
With changes expected in the wake of the recent elections, there is concern that the Act could be repealed, and that this could affect the upcoming open-enrollment season for ACA health plans.
Meanwhile, the government is encouraging people to go ahead, consider the options, and sign up for health care.