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by LynfromNM on October 26th, 2006
People in the US who have health insurance usually get it through their employers. Often the employers pay a portion of the premium for their employee, up to 100% (like mine). If the employee has a family, the company pays a portion of their premium too, and the rest of the premium is deducted from one's paycheck. The health insurance company determines what doctors one will see (different doctors are associated with different plans). In addition to the annual premiums you pay a co-pay for each doctor visit (mine is $15 for my primary care physician, $25 for a specialist). Most doctors and hospitals are further associated with Health Management Organizations (HMOs), which supposedly oversee the actions of the healthcare providers. HMOs set a protocol for treatments of each kind of ailment and insurance companies determine what types of treatment are "covered" by health insurance and to what extent. For example, they might have a protocol to pay for 10 sessions of physical therapy after an injury, but if your doctor says you need more, or you feel you need more, you may be paying out of pocket unless you can justify it to the HMO. HMOs are supposed to focus on preventative measures, such as annual physicals, pap smears, mammograms, etc.
Those whose employers don't pay for health insurance frequently cannot afford the premiums to buy their own health insurance, so they either go to certain care centers who will accept such patients (either paying on a sliding scale based on income, or paid through a federal program such as Medicaid (for chronically ill persons with no income, including the developmentally disabled or mentally ill). Generally, when one is 65 or older, one qualifies for Medicare, a federal program. Medicare is often supplemented by additional insurance paid for by the patient out of pocket or through a pension plan from the former employer (if one is lucky). As Pepe06 said, about 44 million Americans have no health insurance and don't qualify for a federal program, and they are "on their own". They can go to any doctor they choose if they can afford it. "Alternative" treatments such as naturalists are usually not covered by insurance. Acupuncture is now covered by many plans, as are chiropractic treatments.
My dear Lady Fuschia, I hope this gives you some idea. There are a lot of complicated twists and turns, and many differences from state to state. It's more difficult than I thought even to reduce it to paper.
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Comments
No, thankyou, that makes sense. Its just I always got a bit confused watching American TV when they talk about "health insurance" and wondered how it worked. This explains it quite well.
by lady fuschia on October 26th, 2006
Whew
by LynfromNM on October 26th, 2006
Great answer. It's actually a bit similar to private health insurance in England. Only in England, it's not as necessary.
by Carmella on October 26th, 2006
It isn't too disimilar actually is it? Only I suppose ours is weighted towards public and their's is weighted toward private.
by lady fuschia on October 27th, 2006
Yeah but not all employers provide health coverage. I for example don't have any health coverage, I'm pretty much a major illness or accident away from bankrupcy.
by Valparaiso on January 30th, 2007
That situation is addressed in my answer, Valparaiso, in the paragraph beginning "...Those whose employers don't pay...."
by LynfromNM on January 30th, 2007
Good explanation overall, but again, like Val says 'a major illness away from bankrupcy' because there's no such thing as paying out of pocket for even the smallest emergency.
by MyKinKStar on January 31st, 2007