What is the Situation of Private and Public Health Insurance in the USA?

Most of the individuals, about 58 percent of the population of USA have private health insurance to take care of their needs of health coverage. In addition, there are certain public programs like Medicaid, Medicare and SCHIP (State Children's Health Insurance Program) which takes care of the health insurance of the eligible children, elderly citizens and families with low income. TRICARE (previously known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)) along with some of the veteran programs also contributes to the health coverage.

Private health insurance generally provides covers to those who are either not covered in the public funded programs or are just partially covered.

Still there are millions of Americans who are not having any medical health insurance. Some of the studies report this figure to be more than 46 million and even among those who are covered, millions are only partially covered.

Private & Public Health Insurance in USA

The Patient Protection Health Insurance and Affordable Care Act

The Patient Protection and Affordable Care Act which came into existence on March 23, 2010 changed the whole scenario of the health insurance in the US. It makes compulsory for every citizen to be covered under some or the other health insurance in the absence of which fine will be applicable. However supreme court is still considering some of the clauses of the Act.

Some of the provisions under the act are already implemented while others will be implemented in the next few years. The provisions under the Act so far are have focused mainly on children, senior citizens or those who are diagnosed with pre-existing conditions. The provisions in the future are expected to focus on online exchanges and co-ops.

Promoting Individual Responsibility is one of the significant provisions under this Act implemented in 2014 which requires every citizen to either purchase a private health insurance or pay a fine for not having adequate health insurance.

Purchasing Private Health Insurance on Your Own

While some of the individuals are already covered automatically under state funded programs or, as an employer of a company or in part of a COOP but the remaining citizens need to buy private health insurance on their own.

It is very important to pay attention to certain factors like provision for prescription coverage, critical illness coverage etc… while choosing the private health insurance plan. For example, woman would opt for that private health insurance that can cover maternity expenses.

The new law and provisions have helped the individuals to get health insurance with the help of programs run by government. The Insurance providers cannot deny insurance to someone less than 19 years of age on the grounds of pre-existing condition. Such candidates might require being included in the open enrollment period in some cases.

The new provisions have forced the insurance companies to spend a lot of money collected from those availing insurance towards health coverage. The individuals who cannot afford the health insurance may get financial Aid after 2012. The new provisions also allow parents to include children between 19 and 26 years of age in their own insurance plan.

Private Health Insurance Plans: Matching your Needs with What is There-

It is not easy to choose a perfect private health insurance plan that can cover the insurance needs of an individual as well as the other members in the family. It is necessary to analyze your health related current and future needs carefully before opting for a private health insurance plan. Following are some of the points that can help you choose a right private health insurance plan:

  • One Family Plan or Individual Plans: Mostly it is advantageous to purchase a combine private health insurance plan for the whole family but it may not always be a correct choice. You must analyze always try to analyze the benefits against the premiums that you are paying to help you choose the right plan.
  • Is Your Doctor Included In The Private Health Insurance Plan: The private health insurance plans have a predefined list of the hospitals and doctors that they cover. Thus if you have a preferred doctor, always ensure that he is in the list or else you will either end up paying from your pocket or opting for another doctor.
  • Only Choose Relevant Options: The premium of a private health insurance plan increases with the increase in the features it covers. Thus you need to be smart to choose only such features that you need to ensure that premium is low. For example, if you have a wife over 45 years of age, it would be unnecessary to opt for a plan that covers maternity expanses as she is not likely to bear a baby. Also check the list if medicines covered under the prescription plan.
  • High Premiums Today, or in Future: You can generally choose between two types of private health insurance plan to start with: Low Deductible plans and high deductible private insurance plans. High deductible plans are suitable if your current health status is good and you can afford the high cost whereas low deductible private insurance plans are more suitable of your current health expenses are high.

Average Cost of Health Insurance in the United States of America

eHealthInsurance conducted a survey amongst its insurance holders in 2010 and found that on any average the health insurance holder paid USD 167 per month as premium and the average deductible was fond to be USD 2,632. On the other hand in case of family plans, average of the monthly premium was USD 392 with average deductible of USD 3,531.

With the Patient Protection and Affordable Care Act, 2010, the people who cannot afford the cost of health insurance will also be included sooner or later.

  • Medicaid: The new provisions look to extend the Medicaid which was already available for low income candidates who were eligible under the program. As of 2014, the individuals with income less than 133 percent of the federal poverty level can opt for Medicaid.
  • Subsidies: The individuals with income less than 400 percent of the federal poverty levels can seek financial assistance as part of the subsidies offered by government as of 2014. Also the new CO-OP programs as of 2014 offers the candidates to seek health insurance from not-for-profit companies.

As per the statistics from www.coverageforall.org, about 50 million Americans which makes about one third of the population of US are not covered under any type of health insurance plans.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: September 19, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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