The Affordable Care Act (ACA): In addition to making possible purchases of individual and family coverage through online marketplaces, the ACA, more commonly called “Obamacare,” offers subsidies for low- to middle-income families to further help them purchase insurance; it also prohibits insurers from refusing to insure someone on the basis of a pre-existing condition.
Types of Health Insurance Coverage
There are scores of health insurance plans in the United States and each has its own spectrum of what they will cover and at what price. They will depend on a person’s healthcare needs, financial situation, and other preferences.
Health Maintenance Organization (HMO): HMO plans require you to choose a PCP and to obtain a referral from that physician in order to see specialists. These plans normally have the lowest premium, but they do cut into your ability to pick your health provider.
Preferred Provider Organization (PPO): PPO plans allow you to see the most flexibility. You may see specialists and out-of-network providers with or without a referral. They often have higher premiums and out-of-pocket costs than other plans.
Exclusive Provider Organization (EPO): An EPO falls somewhere between the HMO and the PPO. While an EPO is less expensive than a PPO, it does offer some flexibility to see specialists without providing a referral and does restrict care to within the network.
High-Deductible Health Plans: You have higher deductibles-your insurance does not kick in until after you’ve paid out more of the dollars for medical costs. HDHPs are typically used with Health Savings Accounts, accounts you can use to pay for expenses with before-taxed money.
Catastrophic Health Insurance: Catastrophic plans are for young, healthy persons who want low-cost coverage for emergencies. These plans have a high deductible and are only available to the under 30 set, or to those who qualify for a hardship exemption.
Pros and Cons of the U.S. Health Insurance System
The health insurance system in the United States offers numerous benefits but with drawbacks as well. Some of these positive and negative aspects include:
Benefits:
All these health care services could be accessed through insurance. The US has some of the very best facilities and doctors around the world. Insurance can avail high-quality care access.
Preventive Care: Most of the insurance plans offer preventive services, wherein potential issues with health are diagnosed early, thus saving money spent on long-run health care.
Flexibility to Choose Coverage: Flexibility to choose the levels of coverage as well as the quality of care is there in the US system.
Financial protection: Health insurance protects people against the cost of medical services, providing the insured with the comfort of knowing that, in the event of unexpected medical conditions, they will be spared such expenses.
Challenges:
Cost remains a significant challenge. Even for those covered by health insurance, healthcare in the United States is pricey. Premiums, deductibles, co-payments and out-of-pocket maximums quickly add up to sums that become unaffordable for some of them.
Complexity: In health insurance, the United States is characterized as very complex with a wide range of choices, terms, and rules. Many people are perplexed and find it hard to navigate this system, partly because of non-familiar terms.
Coverage Gaps: Even with reform through the ACA, some individuals continue to be left behind-either as persons who cannot afford coverage or as the result of the state choice to not expand Medicaid.
Limit on Choice: Depending on the plan, patients may be restricted in choosing the doctors or hospitals they will go to- thus, limiting their access to preferred providers or specialists.