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Health Care Insurance

What is It

Health insurance is a program that helps pay for medical expenses. It may be purchased privately (non-government) or provided by the government.

  • Private health insurance is when health care coverage is purchased from a private health insurance company, whether provided on a group basis through an employer or union, or purchased by an individual directly from the insurance company.
  • Government health insurance is when health care coverage is funded by a federal, state, or local government agency.

Although specific health plans vary greatly in coverage, policies typically cover medical expenses for some or all of the following; injury, illness, dental, vision, preventative health care, and prescription drugs. Under a wider definition of health coverage is long-term nursing care, long-term custodial care, and disability insurance.

How it Works

The purpose of health insurance is to protect oneself from high or unexpected health care expenses. The amount you pay for this protection is set by the insurance company and paid as a monthly premium or annual tax. The insurance company determines how much to charge by estimating the overall risk of health care expenses and then determining how much money needs to be kept in reserves so that the funds will be available to pay for the benefits as specified in the insurance agreement.

Where Americans Get Health Insurance

Of the approximately 84% of Americans that have some form of health insurance coverage, the US Census Bureau reports that it is provided by the following (percentages are approximate and coverage may overlap):

  • 60% through an employer
  • 9% purchased directly
  • 27% from a government agency

Private Health Insurance

Private health insurance may be purchased on a group basis (employers, unions, trade or industry groups) or purchased by individuals. The cost of health insurance varies by group or individual based on a fee schedule set by the insurance company. Rates are often influenced by age and geographical region. The range of available plans are similar between those provided through an employer and those purchased individually, although individual plans, on average, tend to have higher deductibles, co-payments, and premiums.

The largest private health insurers in the United States are UnitedHealth, WellPoint, Aetna, Cigna, and Humana.

Government Health Insurance

Among the people in the United States covered by some type of health insurance, approximately 27% received their insurance coverage through a government agency. The largest government health insurance programs are:

Medicare
Federal health care insurance program for people 65 years of age or older and certain people with long-term disabilities under 65 years of age.

Medicaid
Joint federal and state health care welfare program for qualifying low-income individuals and families.

Health Care

SCHIP (State Children’s Health Insurance Program)
Joint federal and state health care insurance program for low-income children whose parents do not qualify for Medicaid coverage yet cannot afford to buy private insurance.

TRICARE or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services)
Military health care program for active duty and retired members of the military, their families, and survivors.

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs)
Military health care program for eligible veterans, veteran’s dependents, and survivors of veterans.

VA (Department of Veterans Affairs)
Military health care program which provides medical assistance to eligible veterans of the Armed Forces.

State Plans
State sponsored health insurance plans for low-income individuals without other insurance, may by called different names in different states.

IHS (Indian Health Service)
Health care program administered by the Department of Health and Human Services for eligible American Indians.

The Health Insurance Debate

The issue of health care is considered a priority by a majority of Americans and most believe the current health care system needs to be changed. While there is agreement that something needs to be done, the debate is focused on how this is to be accomplished. Some believe that health care should be a right or privilege that is extended to all citizens regardless of the ability to pay and others believe that health care is not a right and therefore the government should not be responsible for providing coverage. Even among those that support providing universal health care, not all agree that it should be mandatory. The issues surrounding health care reform and universal health care is not limited to the uninsured, but affects all Americans.