Introduction
Choosing proper healthcare coverage is an important task for every American citizen. Coverage consists of health benefits, that is, healthcare items and services included in a healthcare insurance plan (“Benefits,” n.d.). Health insurance programs help ensure the broadest possible coverage of the population with medical care (Keisler-Starkey & Bunch, 2022). The main difference between coverages lies in the sources of payment. This essay will discuss employer-sponsored insurance, the Affordable Care Act (ACA) Marketplace, Medicaid, Medicare, and private health insurance.
Employer-Sponsored Insurance
Employer-sponsored insurance is a type of health benefits coverage that many employers offer to their employees. For example, in 2016, 54% of Americans with insurance had such a plan (Frost et al., 2018). This coverage is typically provided as part of an employee’s compensation package and is usually paid for in part or whole by the employer (Green, 2020). It covers some medical services, including emergency care, hospital stays, and outpatient visits. The critical aspect here is that employees should carefully check the insurance content, which is often initially selected by a third party.
Affordable Care Act (ACA) Marketplace
The Affordable Care Act (ACA) was signed into law by Barack Obama in 2010. It is a government-funded program that provides health insurance for individuals and families who do not have access to employer-sponsored insurance (Green, 2020). This program was created to make healthcare services more accessible to people in need. For these purposes, a marketplace was created where people can compare different health plans and select one that fits their needs and budget.
Medicaid and Medicare
Medicaid is a joint federal and state program that provides health coverage to low-income people. In this case, the federal government provides the majority of the funding. This insurance plan covers preventive and outpatient care, hospital treatment, emergency services, and mental health care. To obtain such insurance, it is necessary to consult with the state’s Medicaid office and clarify whether the client’s characteristics suit this program’s conditions.
On the other hand, there is Medicare, a federal health insurance program for people who are 65 or older, those under 65 with specific disabilities, and people with End-Stage Renal Disease (ESRD). Medicare is divided into four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage) (Health Insurance, n.d.). Part A and Part B are known as Original Medicare, and Part C and Part D are offered through private Medicare Advantage and Medicare Prescription Drug Plans, respectively (Health Insurance, n.d.). Medicare covers the same wide range of medical services as Medicaid. In addition, the insured person gets the opportunity to update information about their insurance and plan annually.
Private Health Insurance
Private health insurance is a type of health benefits coverage that individuals and families can purchase from an insurance company. Typically, customers can choose this insurance according to their needs, as private companies offer many plan configurations. These types of insurance plans vary in cost and coverage, so individuals and families must compare programs before purchasing one. The advantage of this type of insurance is the ability to personalize the insurance package and adjust it to one’s needs and income level.
Conclusion
Health benefits coverage can come from multiple sources, such as employer-provided insurance, the ACA Marketplace, Medicaid, Medicare, and individual private insurance plans. These differ in the source of payment (government, employer, or personal budget), the composition of the packages, and availability. It is important to note that the current healthcare system in the US creates disparities because complete coverage is not available to many families. Individuals seeking insurance must research and estimate their options and find the best coverage for their needs and budget.
References
Benefits. (n.d.). HealthcareGov. Web.
Frost, A., Barrette, E., Kennedy, K., & Brennan, N. (2018). Health care spending under employer-sponsored insurance: a 10-year retrospective. Health Affairs, 37(10), 1623-1631. Web.
Green, M. (2020). Understanding Health Insurance: A Guide to Billing and Reimbursement-2020. Cengage Learning.
Health Insurance. USAGov. (n.d.). Web.
Keisler-Starkey, K., & Bunch, L. N. (2022). Health insurance coverage in the United States: 2021 current population reports. U.S. Census Bureau. Web.