A PondLeap Series: Healthcare in the United States
Healthcare in the United States is one of the biggest question marks for people when they are looking to make the move. For foreigners and locals alike, the system can be confusing, overwhelming, and incredibly frustrating. Even for those who were born here, the system doesn’t always make sense. So PondLeap is creating this series to simplify and break down some of the largest concepts and answer some of the most pressing questions about how healthcare works in the United States.
Where to get health insurance in the U.S.?
First up for this series…where can you even get health insurance in the United States? There are a couple of different options when it comes to obtaining health insurance. Where you go can depend on a number of different factors including your age, your employment status, and your financial situation.
Private Health Insurance
Private health insurance can come in a few different forms and is the unique way that the United States handles insurance, instead of a government-backed system. Private health insurance allows for flexibility in plans and coverage and can choose plans that fit your and your family’s needs and budget.
As there is not a universal, or single-payer system in America, when most people think of healthcare, they think of private, employer-provided healthcare, as this seems to be the easiest and most straightforward way to obtain coverage
Employer-provided healthcare is typically offered to full-time salaried employees as a benefit of employment. An employee has a choice between pre-selected plans, and in many cases, the employer will cover a portion of the costs. However, the employees, in most situations, are still required to pay a portion of the costs associated with the chosen plan.
In addition to coverage for yourself, you may also receive coverage for other family members. This coverage can cover your spouse and children (up to the age of 26). This allows for some flexibility, especially if both spouses are employed, to choose the best option for your family.
Federal or State Marketplaces
The Affordable Care Act (ACA or better known as Obamacare) made private insurance more widely available to those who might not be able to obtain employer-provided insurance. This served to fill a gap and enable those who were self-employed or working jobs that didn’t offer this as an employment benefit to still be able to obtain medical coverage.
The plans offered under the ACA are very similar to the employer-sponsored plans, but the individual or family will need to cover the entire cost of the coverage themselves.
Plans are made available for purchase through federal or state marketplaces where you can compare and choose plans that work best for you.
In order to obtain coverage, you must enroll during the “open enrollment” period, which usually takes place towards the end of the year (in November). You may also enroll when special circumstances cause something in your needs to change such as marriage, children, change in job status, or a move to a different state.
Government Programs for Health Insurance
The United States does have some government-sponsored health insurance programs. However, these are not universally available to everyone, and still require payment in many cases. There are very specific groups that are able to obtain coverage through these programs.
Medicare is a government insurance program for the following eligible individuals:
- People that are 65 and older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (ESRD)
Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Other Ways to Obtain Health Insurance
Below are a few less common ways to obtain individual or family health insurance. However, if you are eligible, these are additional options to ensure that you are covered.
Those who served in the military may be eligible to receive healthcare through the Department of Veteran’s Affairs (VA). Those who served in the active military, naval, or air service and didn’t receive a dishonorable discharge are eligible for VA benefits.
TRICARE is a health insurance program provided for active military members. Eligibility is available for:
- Uniformed Service members and their families,
- National Guard/Reserve members
- Former spouses
- Medal of Honor recipients and their families, and
Others registered in the Defense Enrollment Eligibility Reporting System (DEERS).
COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA is to help individuals when there is a change in employment status. This is made available in order to prevent a lapse in coverage during transitions and is usually made available to employees after they have been terminated from employment. COBRA lets workers and their families remain in the employee’s group health insurance plan for a limited time after a change in eligibility. Typically, you have 60 days to elect COBRA coverage. Under coverage, any amounts that the employer had previously paid, will be required to be covered by the individual.