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Health insurance plans in USA

Health insurance plans in USA
Health insurance plans in USA

With health insurance plans in USA, it is possible to avoid the exorbitant cost of medical care. It is common knowledge that America has the most expensive healthcare system in the world.

Basic medical services have become a luxury only the wealthy can afford. It’s so severe that immigrants now travel back to their home country just to get treatment at an affordable rate.


However, with the introduction of health insurance, Americans now have avenues to escape the grueling cost of healthcare. It becomes paramount to understand how they work to partake of the benefits they offer. As you read on, you will discover one or two plans to help you avert the crippling effect of medical expenses on your finances.

How do health insurance plans in USA work?

Upon signing a contract with an insurance company in the USA, individuals receive coverage based on the terms of their policy. Rather than spending thousands of dollars for each procedure, their premium qualifies them for coverage. It is important to note that coverage costs are not solely dependent on the services you access. Charges like copay, deductibles, and coinsurance are factored in to decide your premium.


Next, policyholders are placed into a risk pool with individuals with similar policies. Within this pool, insurers rotate coverage to accommodate everyone’s claims, taking into consideration the urgency and risk level of each claim.

Private companies are the primary providers of health insurance plans in America. While each company offers unique coverage features, the US, under the Affordable Care Act, ensures consistency in the essential benefits policy providers offer.

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Some of the benefits you can expect from any policy provider include;

  • Preventive services
  • Outpatient care
  • Laboratory tests
  • Prescription drugs
  • Rehabilitation services
  • Hospitalization

Types of Health Insurance Plans in USA

  • Health maintenance organizations (HMOs): HMOs provide a list of hospitals and healthcare providers that users can access all under the plan’s network. Here, you expect coverage for preventive care and reduced copayments. In case there’s a need for a specialist, policyholders need a referral from their primary care physician.
  • Preferred provider organization (PPO): Here, you can visit healthcare providers outside your plan’s network even without your PCP’s approval. While this is acceptable, PPOs still charge higher premiums and out-of-pocket costs for these services
  • Point of Service (POS): This is a combination of HMOs and PPOs in the sense that users can go for either in-network or out-of-network services. Nevertheless, a PCP referral is still necessary and coverage comes with higher premiums.
  • Exclusive Provider Organization (EPO): This, like PPOs, has traits of both HMOs and PPOs but doesn’t enforce a PCP or referrals for specialist care. Also, they charge lower premiums and will not cover out-of-network services unless it’s an emergency case

Benefits of Health Insurance Plans in USA

  • Assists the disadvantaged community: Government-sponsored health plans target the vulnerable in the community and cater to their healthcare needs. People in this category may be living with disabilities, low-income earners, or seniors. Plans like Medicare can support those who can’t afford insurance on a normal day.
  • Faster access to quality health care: Medical insurance gives you the courage to walk through health facilities you would ordinarily avoid. As an insured person, you have the right to visit the best doctors, healthcare facilities, and specialists whenever you choose. This means you’ll get faster diagnosis, prescription, and preventive care, which you need for effective health management.
  • Financial protection: The good part about signing up for a plan is the cost-sharing mechanism it provides. Whatever expenses you attract from medical care can be split with your insurers to avoid financial hardship


Finally, you must never forget that health care in America is far from cheap, and you are expected to pay for every service you receive. Therefore, while health insurance is optional, it is necessary for financial protection.



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