Supporters of a public plan, such as Washington Post columnist E. J. Dionne, argue that many places in the United States have monopolies in which one company, or a small set of companies, control the local market for health insurance. Economist and New York Times columnist Paul Krugman also wrote that local insurance monopolies exist in many of the smaller states, accusing those who oppose the idea of a public insurance plan as defenders of local monopolies. He also argued that traditional ideas of beneficial market competition do not apply to the insurance industry given that insurers mainly compete by risk selection, claiming that "[t]he most successful companies are those that do the best job of denying coverage to those who need it most."
The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises in premiums, and a vicious cycle of higher premiums-leaving members would ensue.
Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. Such plans are routinely part of national health insurance programs. For example, in the province of Quebec, Canada, prescription drug insurance is universally required as part of the public health insurance plan, but may be purchased and administered either through private or group plans, or through the public plan.
The insured person has full freedom of choice among the approximately 60 recognised healthcare providers competent to treat their condition (in their region) on the understanding that the costs are covered by the insurance up to the level of the official tariff. There is freedom of choice when selecting an insurance company to which one pays a premium, usually on a monthly basis. The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium.
Types of Coverage: All of the health plans sold through the Marketplace are offered by private insurance companies and are required to meet minimum requirements. All of the plans are required to cover a comprehensive set of benefits that includes hospital care, doctors’ visits, emergency care, prescription drugs, lab services, preventive care, and rehabilitative services. Before choosing a plan, individuals will be able to see whether their healthcare practitioner participates in the plan’s network (if choosing a network plan). Individuals will be able to choose the plan that best meets their needs and budget. Individuals with low-incomes may instead qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program.
Erica Block is an Editorial Fellow at HealthCare.com, where she gets to combine her interest in healthcare policy with her penchant for creating online content. When she isn't reading or writing, Erica can be found wandering around Brooklyn, playing softball, or listening to podcasts. She counts music, rescue dogs, and lumberjack sports among her greatest passions. Follow Erica on Twitter: @EricaDaleBlock
The quality of medical care available in the United States is generally of a high standard. In the United States, health care is provided by private hospitals and clinics. This requires citizens to have private medical insurance. Often, an employer provides insurance that covers the employee and their immediate family. Increasingly, due to rising costs, employees are required to help cover the cost of medical insurance.
For periods of less than one year in the US, a travel medical plan may be enough to cover your needs. For younger travelers wanting basic emergency medical insurance (instead of comprehensive major medical cover), a travel medical plan will work well. Most travel medical insurance plans provide coverage for accidents or illness, saving you from large medical bills if you require a visit to the doctor or hospital while in the U.S. as well as give you access to universal pharmaceutical care and translation services, should they be required. For more, see:
Health insurance primarily protects individuals from the prohibitively high costs of surgical procedures, inpatient hospital care, and emergency attention. Though health insurance itself can become costly for a family, it is only a small fraction of the potential costs associated with unforeseen illnesses and emergencies (for example, the diagnosis and treatment of cancer or a heart attack).
An alternative proposal is to subsidize private, non-profit health insurance cooperatives to get them to become large and established enough to possibly provide cost savings Democratic politicians such as Howard Dean were critical of abandoning a public option in favor of co-ops, raising questions about the ability of the cooperatives to compete with existing private insurers. Paul Krugman also questioned the ability of cooperatives to compete.
Create a checklist of family health insurance needs. Make a list of health insurance coverage preferences you know your family will require. For example, should prevention or major medical coverage be the priority? Will dental, vision, and prescription coverage be necessary? Once complete, the checklist is used to evaluate and compare health insurance providers, plan choices, and coverage offered.
The average rates paid for health insurance plans are inversely related to the amount of coverage they provide, with Platinum plans being the most expensive and Bronze / Catastrophic plans being the cheapest. The following table shows the average rates a 21 year old would pay for individual health insurance based on plans in the different tiers. Older consumers would see their plans increase according to the age scale set by the federal guidelines.
Private insurers offer a variety of supplemental coverages in both the group and individual markets. These are not designed to provide the primary source of medical or disability protection for an individual, but can assist with unexpected expenses and provide additional peace of mind for insureds. Supplemental coverages include Medicare supplement insurance, hospital indemnity insurance, dental insurance, vision insurance, accidental death and dismemberment insurance and specified disease insurance.
In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40% of insured individuals reporting that their plans do not adequately meet their needs as of 2007.