Explain The Health Insurance Plans And Functions - I

Advantages & Disadvantages

Like home insurance and auto insurance, health insurance is extremely important to protect against huge medical expenditure when you are ill. In present day due to advancement in medical treatment, quality of health care has immensely improved, but it has also resulted in increase in cost of medical care. It is widely known fact that health insurance premium has increased much rapidly compared to increase in salary of workers.

There are about 1500 health maintenance organization and health care providers in America who fund all political parties heavily, which in turn keeps them much mum on health insurance reforms.

These insurance companies in collaboration with hospitals/ medical professionals and other providers corner huge profits. It is estimated that about 44 million people in America are not covered by health insurance.

This is certainly human right abuse in a civilized and developed country. Study also reveals that it is a pure myth that only non working people constitute uncovered population. The break up is 60% are full time rounds the year workers, 23% are other workers and only 17% are non-workers. Health insurance policies normally protect insured person from adverse financial condition they may have to face in the eventuality of serious illness or hospitalization.

Normally health insurance is purchased for self & family members, termed as individual health insurance policies or group health insurance policies, mostly provided by employer to their employees. I addition to above there are MEDICAID & MEDICARE policies. Federal and state governments cover these policies. These are available to mostly aged, very poor and disabled people only.

Now we will discuss these policies enumerating advantages and disadvantages also. How American citizen get health insurance is as below (based on US Census Bureau).

Health insurance provided by employer first began in 1930 in America. The plan was originated by Blue Cross Hospital. Simultaneously H.J. Kaiser offered prepaid group health insurance plan to employees of his construction company.

Group insurance combines pool of people who are healthy and adds few who require costly medical aid. Thus pool of large number accounts for balancing the expenditure of few people, who actually need them. This phenomenon makes group insurance viable and beneficial for both employer as well as employees. Health insurance through employer also provides significant tax benefits to both.

In health insurance plans provided by employer where total premium is borne by him is generally cheaper, compared to plans if purchased by employee himself.

This plan has many disadvantages workers are unable to pay their portion of premium for policies provided by their employers. In case of lay-off or relinquishing service means loosing health coverage for self and family. Circumstances like change in type of job retirement or divorce can lead to cut in the group health insurance sponsored by employer.

Employers normally offer very few plans under health insurance, restricting the choice of suitability for the employees.

Self-employed people or workers whose employers do not offer group policies mostly purchase individual health insurance policies.

Lay-offs, divorce or death of spouse or grown up children can also lead to looking for individual policies. In an individual plan an employer does not bind you, you can change the job, nature of working, start your own work without the risk of losing the insurance cover.

There is wide option and choice to choose from the policies available in open market. Thus you can buy the health plan tailor-made for you. You can buy quality health care and can fully know what you are getting for the money spent on you.

Group insurance In millions
Through employer 175
Individual/ Direct Purchase 27
Medicare 38
Medicaid 33
Military Health Care 10
Uninsured 44

These policies are costlier and cover for less compared to policies sponsored by employers.

Administrative cost is higher. In case of pre-existing medical conditions the premiums is exorbitantly high and most companies deny altogether.

It is experience of personal people that finding a suitable and affordable individual health insurance is extremely difficult.

Medicaid is jointly financed by federal and state governments. It is available to certain category of senior citizens, disabled and low income mothers and their children. Illegibility laws under Medicaid are very tedious because of involvement of federal and state government. These widely differ from state o state. Income, family size and type of disability ascertain illegibility for getting Medicaid.

Many physicians and health care providers are not keen in accepting Medicaid patients due to less or delayed payments.

MEDICARE: people with last stage renal disease, people with permanent disability and seniors above the age of 65 years are benificaries under this plan. Medicare is funded by federal government.

We conclude that present system of health insurance covers majority of population, but still lot of people remain uncovered are left to fund for themselves in case of medical emergencies. History shows that inspite of concerted efforts by several governments for decades, this persistent problem still remains unsolved. There appears no ready made solution for uninsured Americans in the field of medical and health care. So whatever might be your earning, status of health, age, level of employment go get a medical and health insurance plan for you and your family members.

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