What Is Health Insurance?
Health insurance helps cover your medical expenses. You typically pay a monthly premium, and in return, your insurance covers part of the costs when you need medical services, like doctor visits or surgeries.
Most health insurance plans cover:
- Doctor visits
- Prescription medications
- Hospital care and surgeries
How Do You Get Health Insurance?
There are several ways to get health coverage:
- Buy it on your own: Purchase a plan through the individual market.
- Get it through a job: Coverage may be provided by your employer or a family member’s job.
- Public programs: Programs like Medicaid and Medicare help people in the USA who qualify.
Buying Health Insurance on Your Own: Individual Market Plans
When you purchase health insurance by yourself and aren’t part of a group plan, it’s known as individual market coverage. Many people in the USA buy their health insurance through the Affordable Care Act (ACA) Marketplace on websites like Healthcare.gov. This allows eligible individuals to get premium tax credits to make their insurance more affordable.
Tip: An insurance agent or state health insurance “navigators” can help you find the right plan.
Not all health insurance sold outside the ACA Marketplace follows the same rules. Some plans may cover fewer services and may cost more if you have a pre-existing condition.
The Affordable Care Act (ACA): Expanding Health Insurance Coverage
The ACA, enacted in 2010, made it easier for millions of Americans to get health insurance. It also introduced important consumer protections, such as:
- Covering people with pre-existing conditions
- Eliminating limits on coverage (both annual and lifetime limits)
- Providing free preventive care
- Allowing young adults to stay on their parents’ plans until age 26
- Offering premium tax credits to help lower costs
According to the U.S. government, more than 20 million people have benefited from the ACA’s expansion of health coverage.
Qualified Health Plans (QHPs): ACA-Certified Insurance Plans
Qualified Health Plans (QHPs) are certified by the ACA Marketplace and provide essential benefits, including preventive services and hospital care. These plans also limit how much you pay for deductibles, copayments, and out-of-pocket expenses.
Want to explore ACA plans? Visit GetCoveredIllinois.gov to start.
Employer-Based Health Insurance: A Common Option
Most working Americans get their health insurance through their employer. If you’re starting a new job, you will usually have a chance to sign up for health insurance during your enrollment period. For smaller companies with fewer than 50 employees, state insurance regulators often oversee these plans.
Some large employers in the USA choose to self-insure, meaning they manage their own health benefits. In these cases, the U.S. Department of Labor provides oversight. Government employers, like the Department of Defense, are also subject to specific regulations.
Public Health Insurance Programs: Medicaid and Medicare
Medicaid and Medicare are vital public health insurance programs that provide coverage to many people.
- Medicaid: In Illinois, Medicaid offers health coverage for eligible adults and children.
- Medicare: This federal program covers most medical expenses for those aged 65+ and certain disabled individuals under 65. Some people choose to buy additional coverage (like a Medigap policy) to help cover extra costs.
Other Types of Health Insurance
There are several specialized types of health insurance that might meet your needs:
- Short-Term, Limited Duration Insurance (STLD): A low-cost option, but it doesn’t cover as much as comprehensive insurance.
- Basic Hospital Expense Coverage: Covers extended in-hospital care.
- Basic Medical-Surgical Expense Coverage: Covers surgical costs and some hospital care.
- Accident Only Coverage: Provides a lump sum in case of injury or accident.
- Specified Disease Coverage: Coverage for specific illnesses like cancer.
- Long-Term Care Insurance: Helps cover nursing home and assisted living expenses.
Other Non-Insurance Options: Health Care Sharing Ministries
Some people choose to participate in Health Care Sharing Ministries. In these programs, members share healthcare costs with each other, but there’s no legal obligation for the ministry to cover medical bills. Be cautious with this option, as it’s not regulated like health insurance.
What to Remember
Health insurance can be complex, but understanding your options is key to making the best decision. Whether you’re buying coverage on your own, getting it through a job, or applying for a public program, be sure to know what your plan covers and what costs are involved.
For more helpful tips and articles, visit medicaltimes.io.