Health insurance plans in UAS

1. Insurance Plans
in USA
Mohammad Javad Rajabi
Ph.D. Candidate of Pharmacoeconomics and Pharma Management
SBMU
April 2021

2. 0. Background
1. Employer-Based Group Health Insurance
2. Self-Paid Private Insurance
3. Medicare
4. Medicaid
5. Other Government and Private Programs and Charity
6. The Uninsured
7. State Children’s Health Insurance Program
8. Health Savings Accounts (HSAs
Topics
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3. Background
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4. Employer-Based Group Health Insurance
More than half (56.4%) the U.S. population is covered by employer group health
insurance
An employee usually obtains insurance by choosing one of the options offered
through his or her employer, deciding whether to include children and other
dependents, and contributing to the total premium
Almost all large employers provide health insurance benefits, but fewer than one-
third of small employers (those with fewer than 10 employees) do so, and those
that do often make the employee pay a large part of the premium so that fewer
people choose to participate
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5. Employer-Based Group Health Insurance
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6. Almost 10 percent of the population, mostly people who are self-employed or who
work for small companies that don’t provide employee benefits, purchase private
health insurance individually
Individuals acting on their own behalf lack group purchasing power and often pay
significantly increased premiums, even for reduced levels of coverage.
Self-Paid Private Insurance
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7. many elderly people don’t belong to employer groups and would be subject to severe
adverse selection if they purchased insurance individually, the U.S. government created
Medicare, a federal insurance program that covers individuals over age 65 and some
people with disabilities
money for Medicare: tax of 2.9 percent on all wages, general tax revenues and
premiums
Medicare program cost $644 billion in 2019
Part A (hospital) coverage:
1. Inpatient care in a hospital
2. Skilled nursing facility care
3. Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
4. Hospice care
5. Home health care
Medicare
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8. Part B (physician and outpatient services) coverage:
1. Medically necessary services: Services or supplies that are needed to diagnose or treat
your medical condition and that meet accepted standards of medical practice.
2. Preventive services: Health care to prevent illness (like the flu) or detect it at an early
stage, when treatment is most likely to work best.
Part D (prescription drug) coverage: provides protection for people who have
very high drug costs. Everyone who has Medicare is eligible for this coverage
Medicare
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9. People who are poor can’t pay for insurance, and many of them (10 percent of the
population) are covered under the Medicaid program
federal/state program insures people whose incomes are insufficient to pay for
health care, and it also provides supplemental coverage for a substantial number of
elderly people, including a majority of those living in nursing homes
Program design differs from state to state (80% : low-income states, 50%: wealthier states)
Budget: $613.5 billion in 2019
Although Medicaid was designed to cover mothers with low incomes and their
children, it has become the largest funding mechanism for nursing homes
Medicaid
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10. Charity paid for about $58 billion in health care in 2002
workers’ compensation, automobile accident insurance, and similar programs paid
more than $25 billion.
The Department of Veterans Affairs received $22 billion in funding
 Programs sponsored by the Maternal and Child Health Bureau Substance Abuse and
Mental Health Services Administration, Bureau of Indian Affairs, and a variety of
other programs accounted for about another $28 billion n health care
Other Government and Private Programs
and Charity
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11. The Uninsured
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12. The Uninsured
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In 2019, 8.0 percent of people, or 26.1 million, did not have health insurance at
any point during the year
While some uninsured individuals pay large sums out of pocket when they get
sick, a much greater number stay healthy and pocket the cash or, having no
resources, depend on charity when they are ill
What Do People Buy When They Don’t Buy Health Insurance?

13. The Uninsured
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14. State Children’s Health Insurance Program
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SCHIP was enacted by Congress in 1997 as Title XXI of the Social Security Act
to provide $40 billion to increase coverage for the 10million children under the
age of 18 who are uninsured
2018: 9.6 Million Children Enrolled
The program cover children whose parents make too much money to qualify for
Medicaid but too little to afford private insurance
Medicaid Expansion CHIP programs provide the same Medicaid benefit package
as provided for children under each state’s Medicaid state plan

15. State Children’s Health Insurance Program
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16. Health Savings Accounts
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Insurance provides protection against the cost of medical care. Inevitably, this
protection makes people less sensitive to costs; that is, they are more willing to use
extra services and less concerned about finding the best price for the services they
use
In an HSA, a person deposits a set amount of money each year in a tax-advantaged
account, which can then be used to purchase medical services
This is a high-powered incentive to motivate people to pay attention to costs, shop
for the lowest prices, and avoid unnecessary services

17.  Health Economics: Fundamentals and Flow of Funds, Thomas E. Getzen
 www.medicar.gov
 https://www.census.gov
References
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