What is health insurance?

health insurance

Health insurance is one type of insurance which helps to cover the costs of an insured’s medical and surgical costs.

Insurance companies use”provider” to refer to a “provider” to describe a clinic or hospital, doctor, laboratory, healthcare professional, or pharmacy that offers medical treatment for the individual’s condition.

“Insured” or “insured” is the owner of the health insurance policy, or the owner of an insurance policy for health.

The article below will find out more about the health insurance industry essential, the reasons why it is so as well as the different types of plans available and more details about legislation.

What exactly is it?

Based on the kind of health insurance the person is covered by, either the insured covers costs out of pocket and gets reimbursed or direct payments to service provider.

In countries with no universal healthcare coverage, like those in the United States, health insurance is typically included in benefit packages.

After the introduction of the Affordable Health Care Act in 2010, the number insured people fell by nearly 20 million to the lowest level ever recorded in 2016, as per the Kaiser Family Foundation (KFF).

But, since 2017 onwards, the number of people without insurance increased in 2.2 million, rising from 26.7 million back in 2016, to 28.9 million in 2019. In the years between 2016 and 2019 proportion of those without insurance increased from 10 percent to 10.9 percent. But, the percentage of health insurance holders is still higher than what it was prior to the introduction the Affordable Care Act.

An 2011 report by the Commonwealth Fund states that one-quarter of all U.S. citizens in working age have experienced an interruption in their the coverage of their health insurance. A large portion of those in the study had to pay for health insurance when they lost their jobs or were laid off. jobs.

The KFF says that Black individuals and people with lower revenus tend to be most likely to be without insurance than other categories of people.

The amount of care the patient receives at emergency rooms varies greatly based on the kind of health insurance coverage they have.


There are two primary kinds of insurance for health: public and private or public. There are also some additional, more specific types. The sections below will take a examine each one in greater depth.

Private health insurance

The Centers for Disease Control and Prevention (CDC) declare they believe that their U.S. healthcare system relies heavily on private health insurance. According to the National Health Interview Survey, researchers discovered the following: 63.7%Trusted source of Americans less than 65 years old in the U.S. are covered by a form of health insurance plan that is private.

Government, or public health insurance

Through this kind of insurance, the state will provide healthcare to its citizens by paying a cost. Medicare, Medicaid Medicare, The Veterans Health Administration, and the Indian Health Service are examples of health insurance for the public within the U.S.


Other kinds


Certain people might also identify an insurer based on how it handles its plans and works with providers. Here are a few examples of kinds of plans offered.

Managed health plans

When you take advantage of this type of policy, the insurance company will be able to contract with a group of providers who will offer low-cost medical services for the policyholders. There are penalties and other charges added to clinics and hospitals, however they will offer some treatments.

The more costly the policy the more flexible it’s likely to be within the hospitals’ network.

Indemnity, also known as Fee-for-Service plans

A Fee-for-Service policy covers treatments equally for providers, allowing the insured to select the treatment they prefer. The insurance company will usually pay 80percent of the cost on an indemnity policy, and patients pay the remaining cost in the form of coinsurance.

Health Maintenance Organization plans

These are companies that offer medical treatment directly to those who are insured. The policy typically has one primary doctor who coordinates all medical needs.

Health Maintenance Organization (HMO) plans usually cover the treatment recommended by the family doctor . They will also have set fees for every medical procedure to reduce expenses. This is generally the least expensive type of insurance.

Preferred Provider Organization plans

The Preferred Provider Organization (PPO) plan is like an indemnity insurance plan in that it permits the insured to see any doctor they like. PPO plans are not limited to just doctors. PPO plan also offers a list of approved doctors with whom it has contracted for costs.

The insurer will not pay for services provided by out-of-network providers. However, those who have PPO plans PPO plan can refer themselves to specialists, without having to see a primary care doctor.

Point-of-Service plans

The Point-of-Service plan is an amalgamation of the HMO plan as well as an PPO plan. The insured has the option of the coordination of all treatments with an primary doctor, or receiving treatment within the insurance’s provider network, or using providers outside of the network. The type of insurance they choose will determine the treatment process.

What is the significance of the insurance plan crucial?

The type of treatment plan that a person follows determines the way they approach the treatment they require and the amount they’ll need to spend for the treatment that they get it.

In 2003 The U.S. Congress introduced a new option called The Health Savings Account (HSA). It’s a mix consisting of HMO plan as well as an PPO plan and an indemnity plan and a savings plan that offers tax advantages. However, for the year 2020 the policyholder will need to combine the plan with an existing health insurance plan that has the deductible to be greater than 1400 dollars for an individual or the equivalent of $2,800 in families.

HSAs are able to top up the coverage of existing plans, and can be extended to cover a wider array of treatment options. If an employer contributes to HSAs on behalf of their employees, the payments are tax-free. HSA through their employees the contributions are tax-free. Individuals can accumulate money in an HSA as long as they’re healthy and use them to cover the eventuality of declining health later in life.

However, people with chronic conditions, such as diabetes may not be able to secure an enormous amount of money in their HSA because they frequently need to cover expensive medical expenses for the treatment of their health issue.


They typically have high deductibles. That means that, even though the cost of premiums may be less, many people end up having to pay the entire costs of any medical procedure.

More overlap occurs as plans types change. The lines between different types of policies are becoming increasingly obscure.

Most indemnity plans employ managed care strategies to manage costs and ensure that there is enough money to cover the appropriate costs. In the same way several managed care programs have adopted a few features of Fee-for-Service plans.


The U.S., having some level coverage is legal required under the Affordable Care Act. Anyone who is not insured is required to pay a fine.


However the policymakers eliminated the individual mandate from the Affordable Care Act in the year 2019. The insurance requirement is not a personal legally binding obligation within the U.S.

If the insurance also includes children within the family A person can be covered by their parents’ insurance until 26 years old regardless of whether they’re:

  • He got married
  • Living away from home
  • They are not financially dependent on their parents financially
  • are eligible to be covered by the employer’s insurance

Insurance is controlled at the state at the state level, which means that purchasing an insurance policy in one state is different than purchasing one in another.

Although state legislation may affect the cost of insurance but the most crucial decision about the coverage of a person and reimbursements fall with the insurance company. The insured should get your broker, or client care representative explain the effect of any new legislation that affects their specific policy.


Health insurance covers the expenses of an insured’s medical and surgical costs. There are a variety of plans and they differ in regards to what they cover and the manner in which the insured is able to access treatments.

At present, everyone living in the U.S. must have some kind of health insurance. Any person who does not have insurance may be required to pay an amount of money.

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