United States Health Insurance
Health Insurance Options
In the United States, health insurance is available through public and private insurers. Public options have qualification requirements, while private insurance can be purchased by almost anyone.
Oftentimes, employers offer employer-sponsored insurance plans. These plans cover 55% of Americans.
Public Health Insurance
Public health insurance is funded by federal taxes, and covers about one-third of Americans. There are 3 main government health insurance programs:
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Medicare
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Medicaid
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Children's Health Insurance Program
Medicare
Medicare is for U.S. citizens and residents who are over 65 and those under 65 with long-term disabilities or end-stage kidney failure.
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Medicare encompasses 4 parts:
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Part A: fee-for-service hospital insurance for everyone.
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Part B: fee-for-service medical insurance for everyone.
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Part C: optional Medicare Advantage, where beneficiaries enroll in a private health maintenance organization (HMO) or a managed care organization.
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Part D: optional outpatient prescription drug coverage through private carriers.
Medicaid
Medicaid provides health care for low-income families, the blind, people with disabilities, low-income pregnant women and infants, and children up to age 18. It is managed by state governments, and so qualifications vary by state. In order to become a Medicaid beneficiary, it is necessary to apply and/or enroll every year. The majority of Medicaid coverage (2/3) is provided through managed care organizations.
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In Arizona, Medicaid is managed by the Arizona Health Care Cost Containment System.
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Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program is designed for families who earn too much to qualify for Medicaid, but too little to afford private insurance. It currently covers 9.6 million children, and is offered as an extension of Medicaid or an independent program, depending on the state. ​
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In Arizona, CHIP is managed by the Arizona Health Care Cost Containment System.
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Private Health Insurance
Private health insurance covers 67% of Americans.
Most of this is through employer-sponsored programs. These are health insurance plans for employees that cover the employee and their dependents. Employers usually offer multiple plans, and will cover part of the premiums.
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Some employers don't offer health insurance plans. The Affordable Care Act created a federal health insurance marketplace, where individuals can purchase health insurance and dental coverage. Available at healthcare.gov, the Marketplace offers reduced costs and premium subsidies for eligible customers. Almost anyone can purchase health insurance through the Marketplace, but benefits are only available to some.
Small businesses (1-50 employees) can offer insurance through the Small Business Health Options Program.
High Deductible Health Plan
High Deductible Health Plans (HDHP) have lower premiums, but higher deductibles. These can be helpful for people who don't typically require much health care, since they won't have to pay as much every month but are still covered for extremely large bills.
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When patients purchase a plan that qualifies as an HDHP, they may also be able to set up a Health Savings Account. A Health Savings Account allows consumers to set aside funds in a tax-free account that can be used to pay deductibles and other health costs. They are ideal for patients that want the lower premiums HDHPs offer, but still need more frequent care.
This chart, from HealthCare.gov, shows 2020 price regulations for HDHPs.
“Glossary.” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, www.healthcare.gov/glossary/.
“High Deductible Health Plans (HDHPs) & Health Savings Accounts (HSAs).” HealthCare.gov, 2020,
www.healthcare.gov/high-deductible-health-plan/.
“Managed Care.” MedlinePlus, U.S. National Library of Medicine, 20 Sept. 2018,
medlineplus.gov/managedcare.html.
Tikkanen, Roosa, et al. “United States.” Commonwealth Fund, The Commonwealth Fund, 5 June 2020,
www.commonwealthfund.org/international-health-policy-center/countries/united-states.
“What Is AHCCCS Managed Care?” AzAHCCCS.gov, Arizona Health Care Cost Containment System,
www.azahcccs.gov/AHCCCS/Downloads/What%20is%20AHCCCS%20Managed%20Care.pdf.