Health Care Insurance

health care safety and quality


Health Insurance Definitions



CPS Health Insurance Definitions

The Census Bureau broadly classifies health insurance coverage as either Private (non-government) coverage or Government-sponsored coverage.

Private Health Insurance
Private health insurance is coverage by a health plan provided through an employer or union or purchased by an individual from a private health insurance company.

Employment-based plans
Employment-based health insurance is coverage offered through one’s own employment or a relative’s. It may be offered by an employer or by a union.

Direct-purchase plans
Direct-purchase health insurance is coverage though a plan purchased by an individual from a private company.

Government Health Insurance
Government health insurance includes plans funded by governments as the federal, state, or local level. The major categories of government health insurance are medicare, medicaid, the State Children’s Health Insurance Program (SCHIP), military health care, state plans, and the Indian Health Service.

Medicare
Medicare is the Federal program which helps pay health care costs for people 65 and older and for certain people under 65 with long-term disabilities.


Medicaid
Medicaid is a program administered at the state level, which provides medical assistance to the needy. Families with dependent children, the aged, blind, and disabled who are in financial need are eligible for Medicaid. It may be known by different names in different states.

SCHIP
SCHIP, the State Children’s Health Insurance Program, is a program administered at the state level, providing health care to low-income children whose parents do not qualify for Medicaid. SCHIP may be known by different names in different states

Military health care
Military health care includes TRICARE/CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs (VA).

TRICARE/CHAMPUS
TRICARE or CHAMPUS is a military health care program for active duty and retired members of the uniformed services, their families, and survivors.

CHAMPVA
CHAMPVA is a medical program through which the Department of Veterans Affairs helps pay the cost of medical services for eligible veterans, veteran‘s dependents, and survivors of veterans.

VA
The Department of Veterans Affairs provides medical assistance to eligible veterans of the Armed Forces.

State-specific plan
Some states have their own health insurance programs for low-income uninsured individuals. These health plans may be known by different names in different states.

Indian Health Service*
Indian Health Service (IHS) is a health care program through which the Department of Health and Human Services provides medical assistance to eligible American Indians at IHS facilities. In addition, the IHS helps pay the cost of selected health care services provided at non-IHS facilities.

*After consulting with health insurance experts, the Census Bureau modified the definition of the population without health insurance in the Supplement to the March 1998 Current Population Survey, which collected data about coverage in 1997. Previously, people with no coverage other than access to the Indian Health Service were counted as part of the insured population. Subsequently, the Census Bureau has counted these people as uninsured. The effect of this change on the overall estimates of health insurance coverage was negligible.

Source: http://www.census.gov/

Do you have choices with your healthcare?


Things have changed a lot since the 1970s, when most people in the United States who had health insurance had indemnity insurance. Indemnity insurance is often called fee-for-service or traditional health insurance. This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service provided to the patient—that is, you or a family member covered under the policy.

With fee-for-service insurance, you go to the doctor of your choice, and you submit a claim to the insurance company for reimbursement. Often, your doctor or hospital will submit the claim for you. You will only be reimbursed for “covered” medical expenses; that is, the covered services listed in your plan’s benefits summary.

When a service is covered under your policy, you can expect to be reimbursed for some—but generally not all—of the cost. How much you will receive depends on your policy’s coinsurance and deductibles. You will be responsible for the portion of the bill not reimbursed by the insurance company. Go to the section on Indemnity Insurance for more information on coinsurance and deductibles.

Today, many Americans who have health insurance are enrolled in a managed care plan, such as a health maintenance organization (HMO) or a preferred provider organization (PPO). For more information on HMOs and PPOs, go to the section on managed care.

When we talk about health insurance, we usually mean the kind of insurance that pays medical bills, hospital bills, and typically, prescription drug costs. This type of coverage includes Medicare and Medicaid, two government programs that provide health insurance coverage for certain populations, such as seniors, people with disabilities, and individuals and families with low income. But there are other types of coverage as well, including disability insurance, long-term care insurance, and other coverage that can offer additional financial protection for you and your family. Information on these types of plans is provided later in this guide.

Source: http://www.ahrq.gov/



Affordable Health Insurance, part 2


Finding affordable health insurance can be a challenge to some and an absolute nightmare to the rest of us. If you’re lucky enough to work for a company that offers health insurance you may not have to worry about finding anything else. However, if you work part-time or are in need of health insurance, you may find yourself up against that challenge. 

Everyone has their own idea of what affordable health insurance and everyone wants the best coverage. Depending on your age, your health and your habits - you may end up paying far more or far less than someone else that you know. A neighbor may have gotten insurance through a certain company for incredibly cheap. You head to the same agency assuming that you can get the same rates. They take into consideration the fact that you smoke and are a few years older and you suddenly get a quote that is twice what they’re paying. It doesn’t seem fair.

The best way to find affordable health insurance is to shop around. You can’t expect to call the first place you find and get the very best deal. You should get at least three quotes from different companies. Depending on what you’re focusing the most of receiving - a low deductible, low co-pay for doctor visits or prescription plans, you can find exactly what you’re seeking as long as you’re willing to be patient and perhaps a little bit flexible. You might find that you have found a great price for a package but your current doctor won’t accept your new insurance. You have to decide if you want to change your doctor or your package. Little decisions like that can have a major impact on the prices that you will pay.

You can search the internet for sites that will allow you to compare varying companies or trying to sell you their packages. If you find a site online that allows you to compare various companies you can email them straight away for quotes or ask for an agent to call on you.

If you are able to find an insurance broker that is local for you they might be your best solution. The broker can listen to what you want to find and search several different companies until they find affordable health insurance that will suit your needs. Shopping around and getting the best quotes is in your best interest. Finding a local broker and putting them to work for you may also be a very wise decision in finding affordable health insurance.

see Affordable Health Insurance part one