Insurers use the term “provider” to describe a clinic, hospital, doctor, laboratory, healthcare practitioner, or pharmacy that treats an individual. The “insured” is the owner of the health insurance policy or the person with the health insurance coverage.
Depending on the type of health insurance coverage, either the insured pays costs out of pocket and receives reimbursement, or the insurer makes payments directly to the provider.
In countries without universal healthcare coverage, such as the United States, health insurance is commonly included in employer benefit packages.
In the U.S., the number of people with insurance decreased from 44 million in 2013 to fewer than 28 million in 2016, according to the Kaiser Family Foundation. The researchers put this down to recent changes in legislation.
A Commonwealth Fund 2011 report informed that one-fourth of all U.S. citizens of working age experienced a gap in health insurance coverage. Many people in the survey lost their health insurance when they either became unemployed or changed jobs.
The level of treatment in emergency departments varies significantly depending on what type of health insurance a person has.
Types
There are two main types of health insurance:
Private health insurance: The Centers for Disease Control and Prevention (CDC) say that the U.S. healthcare system relies heavily on private health insurance. In the National Health Interview Survey, researchers found that 65.4 percent of people under the age of 65 years in the U.S. have a type of private health insurance coverage.
Public or government health insurance: In this type of insurance, the state subsidizes healthcare in exchange for a premium. Medicare, Medicaid, the Veteran’s Health Administration, and the Indian Health Service are examples of public health insurance in the U.S.
In the U.S., having some degree of insurance is currently legally necessary as part of the Affordable Care Act (ACA) 2010. A person without health insurance has to pay a fine.
However, the Individual Mandate in the ACA has been removed from the legislation, meaning that insurance will no longer be a legal requirement in the U.S. as of 2019.
If the policy also covers the children in the family, a person is allowed to be on their parents’ insurance until the age of 26 years, even if they are:
- married
- living away from home
- not financially dependent on their parents
- eligible to be included on their employer’s cover
Insurance is regulated at a state level, meaning that buying a policy in one state is different from doing so in another.
While state legislation can affect the price of a policy, the important decisions about a person’s cover and reimbursements rest with the insurer. People should be sure to have their broker or customer services representative discuss the impact of any changing legislation on their particular policy.
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