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Importance of health insurance
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Health Care in the USA is expensive and only the richest of us can afford to pay the full cost. Having health insurance affords you to the opportunity to get care at any hospital or clinics in the USA for a fraction of the full cost. Health Insurance is designed to help you and your family pay for medical care which includes doctor visits and sometimes your prescriptions. It’s similar to car insurance, where you are responsible for paying a monthly premium weather you use the services provided or not. In return the insurance will pay for a portion of your medical cost should you or a family member use the service. As a participant in health insurance you are required to renew your plan yearly, as plan features and cost sharing portions are …show more content…
Preferred Provider Organizations plans allows you the insure to use providers out of network at your discretion and you’re not required to have a referral from a primary care physician, as HMO does. However, using an out of network means you may pay a greater share of the costs. Point-of-Service plans combine features of HMOs and PPOs to offer more choices for providers. This way if you have a doctor you prefer, but was not a member of the HMO rather her/she are members of PPO now you’re able to continue care with that provider at the in-network cost. Basically it’s similar to HMO where you will have to designate a PCP, and like a PPO you have free range of providers to select from both in and out of network. High Deductible Health Plans (HDH) offers low premiums, but has high deductible and it also comes with money saving account options such as Health Savings Account (HAS). HSA allows you to save money while it grows tax-free, you can contribute to and withdraw from to pay for out-of-pocket medical care expenses such as co-pays or
Due to the Patient Protection and Affordable Care Act signed into law on March 23rd, 2010; health care in the US is presently in a state of much needed transition. As of 2008, 46 Million residents (15% of the population) were uninsured and 60% of residents had coverage from private insurers. 55% of those covered by private insurers received it through their employer and 5% paid for it directly. Federal programs covered 24% of Americans; 13% under Medicare and10% under Medicaid. (Squires, 2010)
On a global scale, the United States is a relatively wealthy country of advanced industrialization. Unfortunately, the healthcare system is among the costliest, spending close to 18% of gross domestic product (GDP) towards funding healthcare (2011). No universal healthcare coverage is currently available. United States healthcare is currently funded through private, federal, state, and local sources. Coverage is provided privately and through the government and military. Nearly 85% of the U.S. population is covered to some extent, leaving a population of close to 48 million without any type of health insurance. Cost is the primary reason for lack of insurance and individuals foregoing medical care and use of prescription medications.
The U.S. healthcare system is very different from Canada’s; in the U.S., most of the citizens within the US are un- insured or under-insured. The U.S. healthcare system operates mostly by the private sector. The U.S. provides a mixture of private insurance, employee-funded, and government programs. As for any direct federal government, funding of health care needs for any of its citizens is limited to programs that include Medicaid, Veteran’s Health Administration Medicare, and Children’s Health Insurance Program, which generates from the taxpayers (McGrail, van Doorslaer, Ross, & Sanmartin, 2009).
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
As I said earlier there are a number of ways to get Health care. The problem is are they affordable? Well this depends on you annual income and living status. There are a number of private insurance programs such as Blue Cross Blue Shield, but many of these private insurance programs are usually policies that are through employers (Macionis, p 245). This is a problem however because only eighty-five percent of employed people receive health insura...
Out of all the industrialized countries in the world, the United States is the only one that doesn’t have a universal health care plan (Yamin 1157). The current health care system in the United States relies on employer-sponsored insurance programs or purchase of individual insurance plans. Employer-sponsored coverage has dropped from roughly 80 percent in 1982 to a little over 60 percent in 2006 (Kinney 809). The government does provide...
Health insurance, too many American citizens, is not an option. However, some citizens find it unnecessary. Working in the health care field, I witness the effects of uninsured patients on medical offices. Too often, I see a “self-pay” patient receive care from their doctor and then fail to pay for it. Altogether, their refusal to pay leaves the office at a loss of money and calls for patients to pay extra in covering for the cost of the care the uninsured patient received. One office visit does not seem like too big of an expense, but multiple patients failing to pay for the care they receive adds up. Imagine the hospital bills that patients fail to pay; health services in a hospital are double, sometimes triple, in price at a hospital. It is unfair that paying patients are responsible for covering these unpaid services. Luckily, the Affordable Care Act was passed on March 23, 2010, otherwise known as Obamacare. Obamacare is necessary in America because it calls for all citizens to be health insured, no worrying about pre-existing conditions, and free benefits for men and women’s health.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
Luckily under the new health care reform law, most people will receive help paying for their healthcare premiums and cost-sharing expenses that people with insurance have to pay out of pocket for doctor visits, and prescription medicine. Families and individuals will be able to receive this assistance with incomes between one hundred and four hundred percent of the federal poverty line. One hundred to four hundred percent makes up at about $23,000 to $94,000 a year assume this is for a family of four.
The steady rise of healthcare costs and the ever increasing cost of health insurance premiums are making it harder and harder for employers to pay healthcare premiums for their employees. In the past, it was almost a given that employers picked up the tab for health insurance coverage. The health coverage was usually exceptional with little or no money paid out of pocket by the individual for the insurance premiums. Those appear to be the “good old days”, with fewer and fewer employers shelling out money for health insurance premiums and demanding a larger percentage to be paid by the employee. Other employers are simply unable to financially provide healthcare coverage for their employees and have stopped all together.
Ans 1) To mandate the insurance or not is a big question to be answered and still there are a lot of problems associated with mandating the Health Insurance in United States. A lot of views have been given by people regarding whether there is need of mandating the Health Insurance or not.
An HMO is a integrated delivery system that combines both the delivery and financial aspects of health care for consumers. Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs are licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays.
In addition, Blue Cross also offers HMO and PPO Plans. These two plans have some similar aspects, in both plans they guarantee these types of coverage’s. For Instance, primary care provider (PCP) from your plan network, your PCP oversees your care and refers you to a specialist, and your care is covered when your doctors and hospitals are members of your plan
Humana continues to grow by implementing new ideas to continue to provide the excellent quality, access and cost of healthcare services to the consumers. Humana is a company that has developed reward and incentive programs for primary care physicians to encourage their development of population health. Humana has quality clinical, preventative and membership quality programs. Humana has given access to over 400,000 doctors, hospitals, pharmacies and ancillary care providers for consumers of their services. Humana point of service plans (POS) reduce the out-of-pocket costs for their consumers who stay within the network of providers. Humana does not require consumers to have a primary care physician (PCP) but has also given consumers the privilege to develop a relationship with doctors to inform them of healthcare decisions, and allow the doctor to know the patient’s medical history to guide them to the appropriate specialists. Humana encourages consumers to know their budget before choosing plans and services. Humana states that it is important that the consumers know what medications their families use or themselves and the services that are need to determined what is the best plan to choose and that is cost efficient. Humana makes it easier to the consumers but having different levels of healthcare plans starting from high to low that best fit the consumer needs. Humana has financial assistance available for many individuals and families to help with the cost of health care premiums and out-of-pocket expenses. Humana offer premium tax credits to those who qualify to save on out-of-pocket costs. Humana offers many different unique plans to fit the needs of their consumers which has made Humana remain as one of the highest health care providers in the world because of the services, incentives and cost sharing programs to help
Health insurance facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health. Many Americans are foregoing medical care because they cannot afford it, or are struggling to pay their medical bills. “Adults in the US are more likely to go without health care due to cost” (Schoen, Osborn, Squires, Doty, & Pierson, 2010) Many of the currently uninsured or underinsured are forced accept inferior plans with large out-of-pocket costs, or are not be able to afford coverage offered by private health insurers. This lack of adequate coverage makes it difficult for people to get the health care they need and can have a particularly serious impact on a person's health and stability.