Health coverage is now more critical than ever, but too many Americans have policies that only provide limited financial protection. Whether through an employer, the individual market, or even Medicare, high healthcare costs and coverage exclusions mean that insurance becomes less protective yearly.
While many people can now get affordable coverage through the ACA, the number of uninsured remains high. That’s because a significant share of the uninsured still has private plans that are too expensive to afford.
Medicare is a government national health insurance program, started in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS). It provides medical coverage to Americans 65 and older.
It is a popular option among the uninsured because it covers most of their healthcare needs, and many people find it easy to use. However, Medicare isn’t for everyone.
Some health policy experts have proposed that Congress allow older adults to buy into Medicare before they reach 65, which could expand their coverage. While this idea has won some supporters, it would be difficult for Congress to create such a program.
Another alternative healthcare for uninsured is subsidized health plans offered through the marketplaces or their state’s expanded Medicaid program. These sponsored plans help lower co-pays, deductibles, and other out-of-pocket costs. They may also cover essential health benefits required by law, such as preventive services.
The federal government and individual states jointly fund Medicaid, which covers many low-income people. State and federal standards and regulations determine eligibility.
Covered populations vary by state, including children, adults (including pregnant women), seniors, and people with disabilities. Some services are mandatory and must be covered by Medicaid, while other benefits can be optional.
Many states also have Medicare Savings Programs, which help pay for Medicare premiums and cost-sharing for low-income individuals. The federal government reimburses each state for a percentage share of Medicaid expenditures based on the average per capita income level.
Several studies have found that expanding Medicaid under the Affordable Care Act has increased coverage and reduced the share of low-income adults without health insurance. They also found that those who gained coverage through expansion were likelier to have a personal doctor, receive preventive care, get routine checkups, and avoid medical debt.
Some states are also considering offering “buy-in” plans to those who qualify for Medicaid but can’t afford to pay for plans on the health insurance exchanges. These policies could be a new way to deliver health care at lower costs to the uninsured and help spur competition among insurers.
A public health insurance program called CHIP for Children’s Health Insurance Program offers pregnant women and children who qualify for accessible or affordable health care coverage. The federal government and states jointly fund it.
It offers many health services, including doctor visits, mental health care, and dental services. It also covers children with special needs, such as physical, occupational, and speech therapy.
However, some families may be required to pay out-of-pocket costs. These costs include enrollment fees and co-pays for doctor visits and medicines.
In many states, a service manager will work with you to ensure your child receives the necessary care. You can find out if your state offers service management by calling the local office in your area.
Families can enroll in a CHIP plan through the health exchange if available. However, premium subsidies are not available in the exchange.
Self-insured plans are another health insurance option many employers offer their employees. Federal law (ERISA) exempts self-funded plans established by private employers from most state insurance laws, including reserve requirements, mandated benefits, premium taxes, and consumer protection regulations.
However, self-insured plans do carry significant risks. For example, if an employer declares bankruptcy or can no longer pay claims, the employee may be left without health coverage.
Despite this, many large employers are increasingly choosing to self-insure. Nearly half of all employers with over 1,000 employees now have a self-insured health plan.
Self-insurance is particularly popular among business establishments and unions, but it also has a higher participation rate among religious organizations, governments, schools, and associations. For these groups, the high cost of insurance coverage can be offset by assuming risk continuously and spreading it among the employer, insurer, and third-party administrator. In addition, the ability to adjust experience-rated premiums and retain a portion of these funds until needed can help improve cash reserves.
Private insurance is a type of health insurance purchased by individuals or businesses. It is generally more regulated than government-run programs like Medicaid and Medicare. It includes various types of plans, including short-term health plans, fixed indemnity insurance, accident supplements, dental and vision coverage, etc.
Uninsured people are less likely to receive needed preventive care than those with coverage, which may increase their risk of chronic diseases and poor health outcomes. They also spend much more out-of-pocket on medical costs, which can lead to debt and bankruptcy.
The Affordable Care Act has made a difference in many ways to make health insurance more accessible and affordable for millions of Americans. The ACA has improved benefit standards and premium financial subsidies, provided access to coverage through the exchanges, and expanded coverage to young adults under age 26. These changes have resulted in a significant decrease in the number of uninsured adults. It has contributed to the national rate dropping from 11.9 percent in 2010 to 5.2 percent in 2019. The decline is especially pronounced among low-income and recently-immigrated adults.