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Doctor's Fees & US Private Insurance Prices Reach Nightmare Proportions... What are some of your alternatives?

 

Health insurance helps Americans maintain their health and receive the best care for illness or injury. But over the last few years, it has become increasingly expensive. Especially the US private insurance sector is seeing a consistent price hike, making it challenging for people to get insured through a private health insurance plan or maintain their existing insurance policy. Many factors are behind the reaching of US private health insurance prices to nightmare proportions, including the complexity of the healthcare system, rising drug prices, increasing salaries of healthcare professionals, and profit-driven healthcare facilities like hospitals or care centers. These factors impact most Americans who rely on private health insurance to get covered. 

The rising costs of private health insurance in the USA force people to look for cheap and affordable alternatives. Here, we have discussed some health insurance options that are the least expensive compared to traditional private health insurance plans. 

HealthCare.gov (The Health Insurance Marketplace)

HealthCare.gov is a governmental health insurance marketplace established by the US federal government under the ACA (Affordable Care Act)/ Obamacare. It's also called "healthcare exchange," a place that offers a variety of affordable health insurance options to qualified Americans. The Marketplace has an open enrollment period that runs from November to January every year. During this period, you can enroll in the health insurance plan of your choice. One of the significant advantages of getting a health insurance plan through HealthCare.gov is the freedom that it offers. You can choose any health insurance plan tailored to your specific coverage needs. 

The Health Insurance Marketplace is a good option for people with pre-existing conditions. No insurer on the Marketplace can reject your application based on pre-existing conditions. HealthCare.gov also increases access to primary and secondary healthcare services with lower premiums and deductibles. 

Health insurance plans that the Marketplace offers are divided into four categories:

  • Bronze Category

Bronze-category health insurance plans have the lowest monthly premiums but the highest deductibles. It means your monthly payments are low, but you need to pay higher while receiving care. Bronze plans require the insured to pay 40% of the total cost of the healthcare services while the insurer pays the remaining 60%. These plans are a great choice for people in good health.

  • Sliver Category

Sliver health insurance plans offer a balance between monthly premiums and deductibles. Premiums and deductibles are both at a moderate level in such plans. With a silver plan, you're required to pay 30% of your total healthcare costs, while the insurance company will pay the remaining 70%. 

  • Gold Category

Gold insurance plans come with high monthly premiums and lower deductibles. These plans are a good choice for individuals with pre-existing conditions. In the gold category, customers pay 20% of healthcare costs, while the insurer pays 80%.

  • Platinum Category

The platinum category works opposite to bronze plans as it comes with the highest monthly premiums but the lowest deductible. In a platinum plan, the customer pays 10% of the total healthcare cost while the insurer pays 90%.

Medicaid

Medicaid is another governmental health insurance program. It’s designed to subsidize healthcare services for low-income American households. Low-income individuals can also qualify for this program if they meet the eligibility criteria. The partnership between the Federal and state governments runs the Medicaid program. The healthcare services offered by this program vary from state to state as it's operated at the state level in contrast to Medicare. 

The federal and state governments have different roles in managing the Medicaid Program. The federal government is responsible for funding the program, while state governments determine its structure, eligibility criteria, and the mechanism through which healthcare benefits are provided to qualified families and individuals. That's why the eligibility criteria for Medicaid vary from state to state. 

Overall, Medicaid can cover four groups of people:

  • Low-income families (or individuals in certain cases)
  • Pregnant women
  • Disabled individuals
  • Citizens with age 65 or above

According to the US Census Bureau reports, around 18% of US residents are enrolled in this program, getting affordable healthcare services than private health insurance marketplace. 

CHIP (Children’s Health Insurance Plan)

CHIP is a state-run health insurance program designed to provide affordable healthcare services to children and mothers from low-income families. The program runs on the state level but is funded jointly by the state and federal governments. According to statistics, millions of children have enrolled in CHIP. Some US states have merged CHIP into Medicaid Program, expanding affordable healthcare to more Americans. 

CHIP covers all essential healthcare services, including child wellness, pediatrician visits, vaccines, and medicines. 

Short-Term Health Insurance

As the name implies, Short-Term Insurance is temporary coverage for unforeseen medical emergencies resulting from an illness or injury. It's one of the cheapest health insurance options for people in good health who don't need a full-fledged health insurance policy. You can also use short-term health insurance to cover the healthcare coverage gap in your existing health insurance policy. 

Concierge Medicine Care

Concierge Medicine, also known as Primary Care Membership, is a health insurance plan in which an individual gets care directly from a medical professional without involving an insurance provider. It's an affordable alternative for people who can't afford a private health insurance plan because the patients are only required to pay for the care they receive, unlike health insurance, where they need to pay premiums even if they don't receive care. 

In concierge medicine care, a physician or doctor offers a concierge membership model as per the healthcare needs of the patient. The patient pays the doctor a retainer on a monthly or annual basis, according to the model. The retainer is usually around $60-$100 a month, in return for which the doctor is obliged to offer a pre-ordained bundle of services to the patient. 

Health-Sharing Plans

A health-sharing plan is a cost-effective alternative to traditional health insurance that involves sharing the cost of medical bills with like-minded individuals. In such plans, a group of people under an organization, like a health-sharing ministry or faith-based community, take a health plan under which if one member of the group needs treatment, then the cost of treatment is paid by all members. In this way, each member of the group can receive affordable healthcare. Health-sharing plans are run by health-sharing ministries. They’re relatively inexpensive compared to traditional individual private plans. 

HDHPs (High-Deductible Health Plans)

Such plans are an affordable health insurance option for people in good health. In an HDHP, you have to pay a small amount in terms of premium. However, you will need to pay a high deductible (maybe thousands of dollars) out of your pocket to get medical treatment before your coverage kicks in. For example, if you take an HDHP with a deductible of $6000 and your treatment bill reaches $16000, you must pay $6000 before your insurance coverage pays the remaining $10000. Therefore, HDHPs are not a good choice for people with pre-existing medical conditions or those who often get sick. 

Conclusion

With consistently surging US Private Insurance prices, it has become difficult for Americans to afford private health insurance plans. Fortunately, there are many cheap alternatives to private insurance out there. You can choose HealthCare.gov, Medicaid, CHIP, Short-Term Health Insurance, Health-Sharing Plans, or HDHPs as per your coverage needs. 

 

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1 year ago
By Wayne G Fraser

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