Insurance in US
Hello,
I have a question about the healthcare insurance in US.
I have heard that it is tied to your employment and the company provides for it.
So here are a couple of questions:
An individual can sign up for a plan through their State’s health insurance exchange or the federal government’s HealthCare.gov website.
It is usually more expensive than getting it through an employer - but works to serve small business owners, freelancers, etc.
A few States (like Massachusetts) have semi-universal systems that cover all individuals that earn under 150% of poverty, independent students, newly unemployed, etc.
A lot of Americans are also covered under Medicare, Medicaid , Social Security and other programs.
Retirees aged 65 and older are eligible for Medicare - a semi-universal federal system that covers pretty much everything and accepted most places.
Also worth mentioning that your first couple points only became true with the Affordable Care Act passing in 2010. Prior to that it was practically impossible to get a private plan, insurance companies would deny coverage for any pre-existing conditions like diabetes or cancer, and the standard low-end plans at many employers were more expensive and covered less. The system is still a complete joke, but it's better than it was before.
Indeed. Prior to 2010 - it was a roll of the dice. If insurance wasn't provided through your work, you had to be lucky enough to live in a State with decent laws preventing some of these predatory insurance practices. Back then, the uninsured rate was close to 19%. Almost 1 in 5 Americans.
Today, that rate is 8.4%. Which hails the victory of the ACA because "91.6% of Americans have insurance" sounds nice. And compared to where we were 13 years ago, it is nice.
In reality, we have 28 million uninsured people, many of whom are children. There's a long way to go.
While I'm personally satisfied with my level of coverage and standard of care, I don't understand how we can comfortably accept a society that bankrupts our most vulnerable residents for being sick. I'm baffled how this wasn't already solved or mostly resolved in my lifetime. Or at least seeing more states take on the Hawaii or Massachusetts health care models.
I’ve run my own business in the US for 16 years. Until recently I pay about $2000/mo for a family of 4. (Wife and I are in our early 40’s, kids are under 10). Recently my wife got new employment and it means we can insure the family with similar (slightly better coverage, (great coverage)) for less than half this amount.
My state offers free insurance. I pay for my own insurance, so I've never used it, but most of the people I know use it and like it.
There is a way, and it is required, but it is much more expensive; therefore people usually pay for the least amount of coverage.
If you fall under a certain income threshold you can get free healthcare through medicare/aid.
There is a way, and it is required, but it is much more expensive; therefore people usually pay for the least amount of coverage.
If you fall under a certain income threshold you can get free healthcare through medicare/aid.
a little more expensive
This is a gross understatement. Companies usually pay 50% or more of the insurance their employees get.
My partner and I pay $200 for the ~$1800/mo healthcare plan through their employer. There was a fully-covered option but the deductibles are so low on this plan it's incredible.
So you get fined if you don't take one of the slightly more expensive plans if you are a freelanced individual?
Yes, because you would be without insurance. A person can buy insurance on an exchange and it is similar in price as employer sponsored insurance - you just have to pay all of it. Typically an employer pays for at least some of the insurance if it is a benefit they offer.
It is worth noting that the fine is captured as part of a person's taxes, so it can be a bit obvuscated. Although in typing this, I vaguely recall a SCOTUS ruling that said the fine wasn't allowed.
It is actually more wild than all of this even! Each state has additional rules/requirements beyond Obamacare. So what is covered in Washington State may not be covered in Texas.
If you need help sorting through insurance, reach out to me - I've done a lot of it as a business owner with two special needs kids.
This is the first time I’ve heard about being fined for not having insurance.
Tv etc has led me to believe if you don’t have insurance you just hope and pray you don’t need to go to a&e. What about homeless people, for example? Is there something in place that issues fines to all the people who don’t have insurance at all? I’m so confused.
On point 2, the individual mandate was repealed in 2018. There's no federal penalty for not having insurance.
Apparently it is still upheld at the state level in 5 states.
There is a way, and it is required, but it is much more expensive; therefore people usually pay for the least amount of coverage.
If you fall under a certain income threshold you can get free healthcare through medicare/aid.
Only some states offer free healthcare for people under certain income thresholds without other qualifications such as being disabled or pregnant. There has been progress with states finally accepting the Medicaid expansion, and there are often "low-income healthcare options" available, but A LOT of people are unfortunately still unable to get coverage because they're too poor.
All states offer Medicaid below the income threshold. Those that have not accepted the expansion payments from the federal government have a much lower income cutoff than those that have accepted it.
Private health insurance is going to cost you ballpark $400/month, provide no coverage for any preexisting conditions, provide no coverage for your family members (just the enrolling individual), you will typically pay the first $10,000 or so each year before your insurer covers any of the costs, and if you end up needing to use it a lot they will cancel you the next year.
Affordable Care Act coverage will cost about the same but cover preexisting conditions, you can usually cap your own cost for regular checkups to $20, and they won’t cancel you the following year unless the insurance company leaves the marketplace entirely.
Private employer provided coverage varies wildly depending on the size of the employer (because they have more leverage in negotiating with insurance companies) and the employer’s own ideas.