Current Scenario of Health Insurance Plans
Purchase of Health Insurance Plan
Currently, in the United States, an individual is not required to purchase a health insurance plan. However, according to Section 1501 of the PPACA, beginning in 2014, “Individuals will be required to maintain minimum essential coverage beginning in 2014. Failure to maintain coverage will result in a penalty of $95 in 2014, $350 in 2015, $750 in 2016 and indexed thereafter.”
Currently, employers are not required to provide health insurance coverage to their employees. However, in 2014, the employers’ responsibility in health insurance coverage will change, according to the PPACA. This is the latest update in a long line of US health care reform efforts.
Using South University Online Library or the Internet, search on the topic of latest health care reforms. On the basis of your research and your understanding of the topic, answer the following questions:
- Track the progress of health care reform efforts in the US history starting with the early 1900s detailing the role of Presidents’ attempting to pass health care reform.
- Give your views on the AALL’s efforts to pass National Health Reform.
- What are the issues of culture, politics, and special interests in the United States that have made health care reform difficult to achieve?
- Of these three issues, which issue do you find to be the most difficult to overcome? Why?
- What is path dependency? What has this been an issue in health reform? How can the power of inertia be overcome?
- What are the advantages and disadvantages of PPACA that was passed in 2010?
What is Private Health Insurance?
Most Americans have private group health insurance through their employers. After that, Medicare and Medicaid, both public programs, cover the next largest population groups.
Private health insurance is not offered by state or federal government, or through an employer. Instead, individuals and families buy these policies directly from insurance companies or through the Health Insurance Marketplace.
When You Might Need Private Health Insurance
Private health insurance is sometimes required if you are:
A young adult 26 years of age or older. Under provisions of the Affordable Care Act (ACA), you can stay on your parents’ health insurance policy until you tun 26 years old. After that, you need your own policy.
Unemployed. If you lose your job, you may be eligible to continue with your employer’s health insurance plan under COBRA. You have to pay the full cost yourself—and it’s notoriously expensive. You may want less-expensive private coverage instead.
A part-time employee. Part-time jobs rarely offer health benefits. If you work part-time, you usually must supply your own health insurance.
Self-employed. Unless you can be covered under a spouse or partner through their job, you must provide your own health insurance if you work for yourself.
An employer. If you start a business and have employees, you might be required to offer them health insurance. Even if it’s not required, you might want to offer it to be a competitive employer who can attract qualified job candidates. In this situation, you will have to shop for a business health insurance plan, also known as a group plan.
Retired (or spouse/parent retires). When you retire, you will likely no longer be eligible for employer-sponsored health insurance. If you are under 65 and not disabled, you will need individual private insurance until you turn 65 and can apply for Medicare. Even after signing up for it, many retirees purchase private Medigap or Medicare Advantage plans to supplement or replace Medicare coverage. By the way, Medicare, Medigap, and Medicare Advantage plans are truly individual—no family coverage allowed. This means that families previously insured through the retiree’s employer may need private insurance when that person retires.
Dropped by your existing insurer. Although the ACA prevents insurers from canceling your coverage or penalizing you for a pre-existing condition—or because you made a mistake on your application—there are other circumstances when your coverage may be canceled or get so expensive you can’t afford it.