Health insurance

INTRODUCTION

Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the

insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.

In health insurance terminology, the "provider" is a clinic, hospital, doctor, laboratory, health care practitioner, or pharmacy. The "insured" is the owner of the health insurance policy; the person with the health insurance coverage.

In countries without universal health care coverage, such as the USA, health insurance is commonly included in employer benefit packages and seen as an employment perk.

Is health insurance coverage a human right or another product one can buy?

In some countries, such as the United Kingdom or Canada, health care coverage is provided by the state and is seen as every citizen's right - it is classed along with public education, the police, firefighters, street lighting, and public road networks, as a part of a public service for the nation.

In other countries, such as the USA, health insurance coverage is seen somewhat differently - with the exception of some groups, such as elderly and/or disabled people, veterans and some others, it is the individual's responsibility to be insured. More recently, the Obama Administration has introduced laws making it mandatory for everybody to have health insurance, and there are penalties for those who fail to have a policy of some kind.

Everybody at some time in their life, and often on many occasions, will need some kind of medical attention and treatment. When medical care is required, ideally the patient should be able to concentrate on getting better, rather than wondering whether he/she has got the resources to pay for all the bills. This view is becoming more commonly held in nearly all the developed nations.

Managing diabetes - researchers from the Kaiser Permanente Center for Health Research in Portlant, Oregon, found that diabetes patients need continuous health insurance coverage for the long-term proper management of their disease .

Since the late 1990s, millions of US citizens have found themselves with absolutely no health cover at all. A collection of several different studies and surveys puts the number of "uninsured" Americans at over 50 million; tens of millions more have inadequate insurance.

A Commonwealth Fund 2011 report informed that 26% of all US citizens of working age experienced a gap in health insurance coverage; many lost their health insurance when they either became unemployed or changed jobs.

Children in the USA with private insurance are considerably more likely to have a primary care physician in America compared to those with public insurance or no insurance at all, according to a study carried out by researchers at the Children's Hospital, Boston. The authors added that levels of treatment in emergency departments varied significantly, depending on what type of health insurance they had.

Americans with long-term or serious illnesses are the least able to pay for their medical bills among the leading developed nations in the world, a Commonwealth Fund International Survey reported in November, 2011.

The Affordable Care Act made it possible for young adults aged between 19 and 25 to join or stay on their parents' health plans in 2011. A Commonwealth Fund report informed that 13.7 million young adults remained or got onto their parents' health plans; this included 6.6 million people who would not have been able to do so if the Act had not been signed.

According to an eHealthInsurance survey carried out in 2010, the average monthly premiums among its customers were $167 per month for an individual, with an average deductible of $2,632. Family plans cost an average $392 per month with a $3,531 deductible

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Two broad types of health insurance or health coverage

Broadly speaking there are two types of health insurance:

·         Private health insurance - the CDC (Centers for Disease Control and Prevention) says that the US health care system is heavily reliant on private health insurance. 58% of Americans have some kind of private health insurance coverage.

·         Public (government) health insurance - for this type to be called insurance, premiums need to be collected, even though the coverage is provided by the state. Therefore, the National Health Service (NHS) in the United Kingdom is not a type of health insurance - even though it provides free medical services for its citizens, it does not collect premiums - it is a type of universal health coverage.

The five main types of health insurance plans in the USA

There are five main kinds of health insurance plans, with indemnity plans at one end, and HMOs (health maintenance organization) at the other end of the spectrum. POS (point-of-service plans) and PPOs (preferred provider organizations) include a combination of features from indemnity plans and HMOs; however, they are usually seen as managed care plans.

In 2003, the US Congress introduced a new option, the HSA (Health Savings Account), which is a combination of HMO/PPO/Indemnity and a savings account which has tax-benefits.

Understanding the differences between different kinds of plans is useful and extremely important when you are considering choosing one for yourself, your family, or employees. However, as plans evolve and add more details and take others away, there is more overlap and their distinctions become progressively blurred. The majority of fee-for-service plans (indemnity plans) use managed care techniques to control costs and to ensure there are enough resources to pay for appropriate care. Similarly, many managed care plans have adopted fee-for-service characteristics.

What are managed care plans?

Managed care plans are health insurance plans that have a contract with health care providers and medical facilities to provide medical care at special prices (lower costs). These providers form the plan's network. The network will have rules, which stipulate how much of the care the plan will pay for.

Restrictive plans usually cost the "insured" less, while flexible ones are more expensive. HMOs will typically only pay for care if you use one of the providers in their network. A primary care doctor (general practitioner) coordinates most of the patient's care. PPOs will cover more of the costs if the insured selects a provider within their network, but will also pay up some of the money for providers outside the network. POS plans allow the insured to choose between an HMO or a PPO each time care is required.

The USA's 25 largest health insurance companies

1.     Unitedhealth Group
2.  Wellpoint Inc. Group

·         Kaiser Foundation Group

·         Aetna Group

·         Humana Group

·         HCSC Group

·         Coventry Corp. Group

·         Highmark Group

·         Independence Blue Cross Group

·         Blue Shield of CA Group

·         Cigna Health Group

·         BCBS of MI Group

·         Health Net of California, Inc.

·         BCBS of NJ Group

·         BCBS of FL Group

·         Regence Group

·         BCBS of MA Group

·         Carefirst Inc. Group

·         Wellcare Group

·         HIP Ins. Group

·         Metropolitan Group

·         Unumprovident Corp. Group

·         Universal Amer Fin Corp. Group

·         Lifetime Healthcare Group

·         BCBS of NC Group