Answers to the most exciting questions about medicine and health insurance in the US

Answers to the most exciting questions about medicine and health insurance in the US

About the American health insurance can diskussirvat indefinitely. And, unfortunately, most of the arguments in this discussion will be made against the current health care system. What is so unhappy inhabitants of the state, and whether or not medical insurance so expensive?

In this article we will try to answer the basic questions you. Indeed, America is not able to provide universal health care. Today, more than 15% of the population, and that tens of millions of people do not have health insurance in view of its high cost and the percentage of Americans whose costs are covered by the employer, drops the last 15 years. But even the existence of insurance does not guarantee success. Medical services are a major factor in the personal bankruptcy of more than 60% of cases. Of those bankruptcies that were caused by medical bills, about 75% of people at the same time had medical insurance. The only sections of the population, for whom the medicine is available - it is the elderly and the very poor. Covering their medschetov - this is the main item of expenditure of the state budget is far from being overtaken even the expenditure on defense.



Medical insurance in SShAObamacare

To date, the price of health insurance in the United States unreasonably high, and if the system does not change, the price of insurance and medicine in general will only grow. One of Barack Obama's campaign promises was to reform and make health care accessible to all Americans. The people of the reform project was called Obamacare. Towards the implementation of the reform has been a lot of obstacles. However, as Obama said, «It came here to stay», the reform was launched and is currently being actively promoted among all citizens, promising reasonable prices for health insurance.

The main objective of the reform - to insure all of the uninsured, who can not afford to purchase insurance at reasonable prices, starting from January 1, 2014. Immediately after the launch of the official website healthcare.gov, which proved to be totally operational in the direction of Obama's comments were sent to criticize all ranging from simple people and to the political elite. But Obama's team is working to improve the project and also invites all to seek affordable insurance online.

Who are the first care program Obamacare? Those who are unemployed or who are employed but do not have access to employer-sponsored insurance, as well as the elderly - that is about all those who obtain access to affordable insurance is limited in view of different reasons.

Health insurance in the US

Can we hope that this program will offer you interesting prices in the insurance market, if you are employed and your employer offers insurance if not with the best prices? Rather no than yes, because you have access to insurance, which is at least in part, but your employer sponsors. Unless, of course, your salary is not less than the minimum. The best way to test the same - apply online healthcare.gov and wait for the results, which are currently not come quite quickly. You will be asked to provide all information about yourself, including your status and income. Then you will be informed if you qualify for free insurance Medicaid / Medicare, or you can apply for a discount to market plans and in what amount. Next, you'll need to compare different insurance plans and choose the most suitable to your look.

Period of purchase of insurance for the next year began Oct. 1 2013 and will be open until March 31, 2014. If insurance is purchased before December 15, 2013, it will take effect from January 1, 2014. If later, the insurance starts from the 1st of next month, provided that you purchased before the 15th of the month (eg, January 14 bought the insurance will be valid from February 1). The policy is purchased for a year, and he will not be able to give during the year, and to make changes to the plan can be purchased only in certain cases (wedding, birth, etc.).

How does health insurance in the US

Some of the largest players in the Illinois insurance market today - a company Aetna, Humana, Coventry, Blue Cross Blue Shield, Cigna, and others. Each of the companies have many choices of insurance, and to determine which one is for you the most suitable, you need to know several concepts:

premium - monthly insurance payments
deductible - the amount you have to pay for medical services before your insurance starts to cover their
co-payment - a fixed amount of co-pay per visit to a doctor, medical services or drugs
co-insurance - costs the insurance company and you in the percentage starts after full payment of the deductible
out-of-pocket limit - the maximum amount spent out of your pocket throughout the year, reaching which, the insurance starts to cover your expenses in the amount of 100%
annual limit - the annual limit of the insurance company cover your medical expenses
Previously, there was still the concept of lifetime maximum limit, which was abolished for all plans purchased after September 23, 2010. According to the amendment, insurers can no longer limit the amount of the costs that accumulate over the life of the insured. With regard to the annual limit (annual limit), he also will be canceled starting from January 1, 2014 goda.Meditsinskaya insurance in the US

Consider the example to better understand how all of these concepts in real life. Suppose the insured person would need an operation worth $ 100,000.

Insurance plan for the patient looks like. Health insurance Plan:

$ 200 - premiums
$ 1,000 deductible
20% co-insurance
$ 3,000 - out-of-pocket limit
$ 2,000,000 - annual limit
Health insurance in the US

So, $ 200 - this is the usual monthly fee for insurance, the patient should make it a regular basis during the insurance year. Furthermore, the insured must pay yourself first thousand for services rendered to him ($ 1,000 deductible). Only after paid deductible, the insurance begins to cover the interest on your account, and the patient must pay a percentage - co-insurance: In our example, the insurance begins to cover 80% of the costs, and the remaining 20% ​​of patients. And this payout ratio will continue as long as the insured reaches the maximum limit of annual costs out of pocket - out-of-pocket limit - in the amount of $ 3,000.

Total, our patient has paid $ 1,000 deductible + $ 2,000 co-insurance = $ 3,000 out-of-pocket paid in full. So now the insurance will cover the remaining $ 97,000. Insurance should cover and any subsequent costs of the patient, until you reach the annual limit of $ 2,000,000. *

* As noted above, annual limit will be abolished in most insurance plans to January 1, 2014. The insurance year shall be planned a year from the first day of your coverage (from 1 July 2012 to 1 July 2013, for example). Once the insurance is over, the whole story starts again.

Some insurance plans may also meet the concept of co-payment - is a fixed amount for certain of medical services, for example, $ 30 per visit to a doctor. Further costs may be covered under two scenarios depending on the plan, either the insurance pays $ 170 at a cost of $ 200 a visit, or repeats the algorithm above. And that is, you paid $ 30, and continue to pay for all services until you reach the deductible, then divide the costs as a percentage of the insurance, and then you reach the out-of-pocket insurance pays your bills in the amount of 100%.

How expensive insurance in the United States?

The average price of health insurance for adults in the United States can be very different in value and ranges on average from $ 150 to $ 500 per month. The final cost depends on the actual type of insurance plan, as well as state, county, age, medical history, income person / family, and other factors. Thus, if a family of 4 people, is about $ 1,000 a month can go to the insurance payments. For many, it is very expensive, and often acts as assistant to the employer.

Often companies fully or partially sponsored health insurance to their employees. Sometimes employers offer paid health insurance and family, but for their prices to be higher, but in any case not more than if you had to buy the same plan on the free market. Children up to 21 years (for full-time students - up to 26 years) are also eligible for the issue of insurance through their parents.

The insurance purchased through an employer does not mean that you will not have to pay anything out of pocket. There will also need to pay a deductible before the insurance starts to cover a percentage of the costs for your care.

What you should know when choosing insurance in the US

In general, many insurance plans can be divided into three main groups:

Catastrophic and Bronze: lower monthly payments (premium), but a high deductible and a lucrative percentage of co-insurance. It is a plan for those who wish to save on your monthly payments and hopes to be healthy next year, although it understands that in the event of going to the doctor will have to spend significant sums on treatment until you reach the deductible. This plan is more unpredictable disease and protect against catastrophic costs of major illness.
What is important, catastrophic plan may be purchased only by people younger than 29 years. "Bronze" also plans to have an age limit.
Examples of the "catastrophic" and "bronze" insurance plans with the Health Insurance Marketplace (healthcare.gov) for 1 adult at age 27, a resident of the State of Illinois, County Cook (not including dental insurance):

1_Lowest 1_Exp 2_Lowest 2_Exp

Medium / Silver: the plan chooses, probably the majority of the population. It offers higher premiums, but deductible and out-of-pocket will be lower, and the percentage of co-insurance amount to approximately 80% to 20%. If you choose this plan people pay substantial sums in the form of monthly payments (premiums), but their pockets are not will suffer in the event of frequent visits to doctors.
Examples of the "silver" insurance plans with Health Insurance Marketplace (healthcare.gov) for 1 adult at age 27, a resident of the State of Illinois, County Cook (not including dental insurance):

3_Lowest 3_Exp

High / Gold and Platinum: the highest contributions to premiums, the lowest deductible and out-of-pocket, co-insurance amount to 80/20 or higher. This plan is beneficial for those who are planning regular visits to doctors and treatment, and the same time, wants to hedge against the high cost of services, but is willing to make significant monthly amount.
Examples of the "gold" and "platinum" insurance plans with Health Insurance Marketplace (healthcare.gov) for 1 adult at age 27, a resident of the State of Illinois, County Cook (not including dental insurance):

4_Lowest 4_Exp 5_Lowest 5_Exp

As you can see, the cost can vary greatly, and the examples of prices were found for the specified parameters as stated above - to a resident of Illinois at the age of 27. The examples can be seen that the higher the monthly payments, the lower the deductible and out-of-pocket maximum, and vice versa. However, when choosing a plan, it is important to pay attention to all the details of the proposed coverage.

Often, each type of insurance covers 100% of preventive visits to the doctor once a year (including a gynecologist) for vaccination, diagnosis associated with these preventive visits. And then already, if you have medical expenses in excess of, the patient pays the deductible, and the subsequent ability you already understand. Thus one should always remember that the best rates are offered every insurance in selecting its network of doctors (in-network), but if you go to the doctors from the outside (out-of-network) all the conditions of payments deteriorate sharply. And if the high / gold plan still offer you a partial sponsor these expenses, the medium / silver offer you is not interesting percentage of co-insurance, a catastrophic plan and does not cover such expenses. It is important to know when choosing insurance costs in advance to learn how broad network of medical institutions and doctors, who are covered by the insurance company, always attentive to the choice of a clinic or doctor.

Insurance for children up to 18 years

Health insurance in the US

In many states, children under 18, regardless of income or immigration status of the parents, relying insurance. As for the state of Illinois, such a program is called All Kids. Its main objective - to provide free or affordable insurance for all children of the state.

This insurance covers the following services:

visits to the pediatrician
immunization
prescriptions for medicines
ophthalmology services, including the production of glasses
stomatology
In addition, All Kids also covers the necessary medical equipment, speech and physical therapy. All children who meet the following three parameters can get insurance All Kids:

The child must be a resident of Illinois, and
The child must be no older than 18 years, and
The child must fit the requirements of the insurance *.
What are these requirements and to whom they apply? Any uninsured child can get this coverage, regardless of income level of the parents. However, there are certain requirements for those children who already have insurance or after the termination of their old insurance has not passed 12 months. In this case, to get All Kids, your family should be approached under the following insurance requirements based on the number of people in the household and total income:

2 people in the family - $ 45.390 or less in a year
3 person in the family - $ 57.270 or less in a year
4 people in the family - $ 69.150 or less in a year
5 people in the family - $ 81.030 or less in a year
The more people in the family, the higher limit. If your family more than 5 people, and above this limit will be $ 81.030 per year. If your children are covered by the insurance plan sponsored by your employer, they can still get All Kids, if you fit the above parameters. This means, for example, if you work with your insurance does not cover dental care, and you come on the requirements, these services will be provided to your child through the All Kids. Details on the official website www.allkids.com.

Free insurance of pensioners and the poor Medicare / Medicaid

Medicare - is a medical insurance for the following groups:

People aged 65 years or older.
People under 65 years of age with certain medical conditions.
People of any age with renal insufficiency in the terminal phase (End-Stage Renal Disease, ESRD) (incurable kidney disease, which requires dialysis or a kidney transplant).
If you have limited income and resources, you may qualify for help paying for health insurance for Medicare and / or the cost of insurance coverage of prescription drugs. For more information, visit www.socialsecurity.gov, call the Department of Social Security (Social Security) at 1-800-772-1213, or call your local department of medical assistance program (Medical Assistance, Medicaid) in your state. If you have questions about Medicare, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). Customers line TTY may call the number 1-877-486-2048.

Medicaid - is a medical insurance coverage available for certain individuals and families with limited income and resources. Terms of counting your income and resources (such as bank accounts or other assets that can be sold for money) depends on what state you live in. The right to participation may also depend on your age, pregnancy, presence of blindness or other kind of disability, as well as US citizenship. Some legal immigrants may also be eligible. If labor and delivery, women provide program Medicaid, her baby will have coverage of up to one year without having to apply for participation.

The main recipients of Medicaid insurance are:

low-income families with minor children, and within the scope of the program AFDC;
Recipients of benefits (Supplemental Security Income), as well as people with disabilities, including the blind;
newborn babies born to mothers receiving this insurance;
Children under 6 years of age and pregnant women in families whose income does not exceed 133% of the federal poverty level (in some states, that threshold may be set up, as well as the age of the children can reach 19 years);
recipients of adoption;
some recipients of insurance Medicare.
If you have questions about the Medicaid (to see if there have the right to participate or enroll in the program), you can call the department of health care program (Medical Assistance, Medicaid) in your state for more information. Visit the website www.medicare.gov/contacts or call 1-800-MEDICARE (1-800-633-4227), to find out the phone number. Customers line TTY may call the number 1-877-486-2048.