How does health insurance work in the US?

if you are wealthy, or at least very well off, you can get the very best healthcare available. You just pay for it as you need it.

How does health insurance work in the US?


If you are destitute or working poor with no savings, and you get sick or injured, you can go to a hospital emergency room, and get enough care to stabilize your condition so you won’t die immediately. Then you are told to leave. You may qualify for Medicaid which may help some. But many states refused to expand Medicaid to the extra millions that need it. Of course, this is mostly in the Republican-governed states.

If you work for a larger corporation and have healthcare insurance where you work (and you pay a significant percentage of the monthly cost, while your employer also pays a significant percentage of the monthly cost. Then when you get sick or injured or get cancer, you can get most of the coverage needed. But there will be expensive co-pays, especially when your stay in the hospital or your pharma costs exceed contract maximums. You may not be bankrupted initially, but when your company lays you off, your insurance stops unless you can fully pay for it on your own. If not, you become a medical bankruptcy case.

If you work for a company, or a couple companies but mostly part-time, which means that you don’t get corporate insurance. If you were able to sign up for ACA (Obamacare) then you can get a basic health insurance policy, and the cost of that policy will be expensive, but if you don’t have the income you may qualify for federal government assistance. The ACA offers a set of preventive care options as well as medical care. This won’t be enough to keep you whole in the event of cancer or a severe medical emergency, or a chronic long-term illness. In which case, you will run out of all money, and end up trying to qualify for Medicaid.

But of course, if are over 65, and not covered under a corporate health insurance policy, you move to Medicare. Medicare is hated by all healthcare professionals since coverage dollars are minimal. At the same time, while you can get a certain level of prescription drug coverage under Medicare, you will run out of coverage, and such coverage won’t cut in until the patient has paid a lot of money out of pocket (This is called the “donut hole” in coverage.)

So most seniors also buy third-party “supplemental” policies that fill in a lot of the holes in Medicare. This can cost anywhere between a few bucks a month, to several hundred dollars a month.

Now let’s address other programs that are aimed at Aid for Dependent Children. In other words, if a family qualifies as poor, or very low income, the children can get a certain level of medical care based on this program. This program is not a single program and differs by state or even city.

So as you can see, healthcare in the US is a very simple procedure.


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