Premiums And Coverage

Health insurance

The term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a social welfare program funded by the government. Synonyms for this usage include "health coverage," "health care coverage" and "health benefits."

In a more technical sense, the term is used to describe any form of insurance that provides protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs such as Medicaid and the State Children's Health Insurance Program, which provide assistance to people who cannot afford health coverage.

In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial careneeds. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40 percent of insured individuals reporting that their plans do not adequately meet their needs as of 2007.

The share of Americans with health insurance has been steadily declining since at least 2000. As of 2010 just under 84% of Americans had some form of health insurance, which meant that more than 49 million people went without coverage for at least part of the year. Declining rates of coverage and underinsurance are largely attributable to rising insurance costs and high unemployment. As the pool of people with private health insurance has shrunk, Americans are increasingly reliant on public insurance. Public programs now cover 31% of the population and are responsible for 44% of health care spending. Public insurance programs tend to cover more vulnerable people with greater health care needs. Many of the reforms instituted by theAffordable Care Act of 2010 were designed to extend health care coverage to those without it.

Prevention

One of the most significant advantages of having health insurance is the ability to prevent diseases through early detection and doctor recommended lifestyle changes. This prevention not only keeps citizens healthier, but it also saves money on the expense of the health care that would otherwise be required to deal with the problem when it arises.

Those without insurance do not usually have the money to spend on regular preventative visits to the doctor when there is no apparent problem. It results in more sickness for uninsured people, which leads to increased health care costs when the industry ends up treating major illnesses without the ability to collect payment form those patients.

Peace of Mind

Having health insurance leads to peace of mind for those who have it. If a nagging problem (such as an unusual pain), persists in someone with health insurance they can go to the doctor without significant out-of-pocket expense and get it checked out even if it leads to diagnostic testing. When they find out they have nothing to worry about or that they are set up to receive the proper treatment, it can be a burden off the shoulders of the patient.

Those without health insurance may suffer with symptoms for months or years without ever knowing what is causing them simply because they know they cannot afford to have it diagnosed and treated. This inaction leads to excessive worry about potential health problems.

Less Lost Time

People with health insurance who get sick can take a sick day from work, visit the doctor, get treated and possibly be back to work in a day or two if the illness is minor. It is an advantage to the employee and employer for this quick and easy access to medical attention, since it reduces their lost time on the job.

Premiums And Coverage

The main disadvantage of health insurance is the fact that it costs money. Even though it can potentially save a patient thousands of dollars by having it, there are still monthly premiums that must be paid in order to take advantage of the benefits.

In addition, the constantly rising premiums do not necessarily indicate a higher level of coverage. Many insurance policies are cutting back on the amount of care they will cover and are strictly limiting the services available to those signing up for new policies.

Complicated Rules

Another disadvantage of health insurance is the complicated nature of using it. Many policies require referrals instead of allowing a patient to go straight to a specialist. They may exclude certain medications from coverage or refuse to pay for supposed “elective” procedures that may not be so elective in the patient or doctor’s opinion.

Lack Of Choice

A significant disadvantage of many health insurance policies is the inability of the insured to choose which doctor they see or which hospitals they use. While some policies offer a wider range of choices, most do not have complete freedom in this regard.

If you or a loved one has ever dealt with a serious illness, you probably understand the difficult decisions people face while seeking medical treatment. When navigating the health care system, it's important to have a working knowledge of your rights as a patient and the payment options at your disposal. This section provides a number of resources on the laws and regulations protecting patients, as well as the federal programs helping vulnerable individuals get the medical services they need. You'll find articles on choosing a physician, patient rights, informed consent, planning long-term care, medical marijuana laws, the differences between Medicare and Medicaid, and more.

Patient Rights

A number of state and federal laws protect patients' interests. These laws cover a wide range of areas related to medical care, patient records, and available treatment methods. For example, informed consent laws require medical professionals to disclose the potential risks, benefits, and alternatives involved with any treatment. The physician must then obtain the patient's written consent before proceeding.

Once a patient has consulted with a physician, the Health Insurance Portability and Accountability Act (HIPAA) prevents the physician or any other medical providers from disclosing the patient's records without his or her consent. Legal issues often arise when a doctor or hospital makes an improper disclosure of a patient's records or fails to obtain informed consent before moving forward with a course of treatment. Finally, a number of states, including California and Colorado, have passed laws approving the use of marijuana as a medical treatment.

Date: 2015-12-11; view: 722