Health Insurance In The United States

Health-Insurance1. Health Insurance Program paying for medical expenses or protection against the cost of medical services:

  • These programs can be either privately purchased or government funded
  • Privately purchased insurance
  • Social Insurance (Funded by Govt.)
  • Social welfare program (Funded by Govt.)

2. Social Insurance Program Medicare:

  • Medicare is a social insurance program in the US
  • Administered by US Federal Govt. since 1966
  • The program covers Americans above 65 years who has paid taxes
  • It also covers people below 65 years with specific medical issues
  • Some disabilities status defined by the Social Security Administration(SSA)
  • People with End-Stage Renal Disease(ESRD) and Amyotrophic Lateral Sclerosis(ALS)

3. Medicare History:

January 1961 First White House Conference on Aging by President Eisenhower July 1965 Congress enacted Medicare under Title XVIII under the leadership of president Lyndon Johnson For people above 65 Years and older 1980 Association with Health Maintenance Organization (HMOs) begun 1997 HMO associations formalized under the leadership of President Clinton as Medicare Part C 1972 Medicare expanded to include benefits for speech, physical, and chiropractic therapy 2003 Program for covered drugs under Medicare was passed under the leadership of President George W. Bush 2006 Medicare Part-D covering almost all drugs came into effect 2001 Covered younger people with Amyotrophic Lateral Sclerosis (ALS).

4. Social Welfare Program Medicaid:

  •  Program for US citizens and legal residents with income up to 133% of the poverty line
  • Besides the above-mentioned criteria, there are a few more state defined categories which include pregnant women, low-income seniors, and other medically needy citizens
  • It is a Federal-state program monitored by CMS which establishes the requirements for quality, funding, service delivery, and eligibility standards
  • Medicaid recipients are enrolled under private health plans or MCOs which receive a fixed monthly premium from the state
  • The health plan or MCOs are then responsible for providing all or most of the beneficiary healthcare needs

5. Medicare Benefits:

  • Part-A Hospital/Hospice Insurance
  • Part-B Medical Insurance
  • Part-C Medicare Advantage Plans
  • Part-D Prescription Drug Plans

6. Medicare Coverage Status:

Above 65 Yrs 86% = 49 Million Below 65 Yrs 14% = 9 Million Medicare Covered Citizens (in Millions) Above 65 Yrs Below 65 Yrs Total Citizens Covered Under Medicare 55,00,000

7. Medicaid History:

In 1965 Social Security Amendments created Medicaid under Title XIX of the Social Security Act 1990 Medicaid Drug Rebate Program and Health Insurance Premium Payment Program was created by Omnibus Budget Reconciliation Act of 1990 1993 OBRA-93 amended section 1927. Brought changes to Drug Rebate Program 1991 OBRA 1990 act helped in adding Section 1927 to the Social Security Act of 1935 and became effective from Jan 1, 1991, 2010 Patient Protection and Affordable Care Act passed in 2010 States adhering to revised and expanded Medicaid eligibility will have a defined Federal Contribution

8. Current Status of State Medicaid Expansion Decisions: WY WI* WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH* NV NE MT* MO MS MN MI* MA MD ME LA KYKS IA* IN*IL ID HI GA FL DC DE CT CO CA AR*AZ* AK AL Adopted (32 States including DC) Not Adopting At This Time (19 States)

9. Some Other Health Programs Like:

  • State Children’s Health Insurance Program (SCHIP)
  • Department of Defense TRICARE and TRICARE for Life programs (DOD TRICARE)
  • Veterans Health Administration (VHA) program
  • Indian Health Service (IHS) program

Thank you so much for reading this article. Hope this article is very helpful to understand Health Insurance In The United States.

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