Supporters of a public plan, such as Washington Post columnist E. J. Dionne, argue that many places in the United States have monopolies in which one company, or a small set of companies, control the local market for health insurance. Economist and New York Times columnist Paul Krugman also wrote that local insurance monopolies exist in many of the smaller states, accusing those who oppose the idea of a public insurance plan as defenders of local monopolies. He also argued that traditional ideas of beneficial market competition do not apply to the insurance industry given that insurers mainly compete by risk selection, claiming that "[t]he most successful companies are those that do the best job of denying coverage to those who need it most."[20]
Health insurance absorbs or offsets healthcare costs associated with, but not limited to, routine health examinations, specialist referral visits, inpatient and outpatient surgery, unforeseen eventualities such as illnesses or injuries, and prescription medication. Health insurance policies are categorized as privately paid for by an individual, publicly provided as a service through Social Security, or commercially arranged by a company as part of an employee benefit package.
The Affordable Care Act (ACA) allows qualifying individuals and families to receive financial assistance to help cover the cost of premiums. Known as the Health Insurance Premium Tax Credit, this subsidy helps people who need health insurance afford their coverage. Healthcare.gov provides a single location where you find out whether you are eligible for the premium tax credit and shop for and compare the different health insurance plans available to you in your state.
The compulsory insurance can be supplemented by private "complementary" insurance policies that allow for coverage of some of the treatment categories not covered by the basic insurance or to improve the standard of room and service in case of hospitalisation. This can include complementary medicine, routine dental treatment and private ward hospitalisation, which are not covered by the compulsory insurance.
Generally, group health insurance plans cover the cost of medical office visits for illness and checkups, hospitalization, emergency room services, ambulance transportation, operations, physical therapy, and even prescription drugs, to provide several examples of potentially covered health care services. But, every plan is different and it behooves an employee to become familiar with the details of his or her employer's plan before the benefit is needed.
We would recommend two options for expatriates moving to live in the USA. Cigna Global is an excellent global insurer with great service and benefits. Cigna Global offers a flexible plan design allowing you to pick and choose different modules to tailor the plan to your needs and budget. The other suggested plan would be GeoBlue Xplorer which offers similar benefits and service to Cigna. GeoBlue Xplorer is offered in association with Blue Cross and Blue Shield of America and comes with the excellent BCBS network of doctors and hospitals associated with BCBS.
Long-term care (LTC) insurance reimburses the policyholder for the cost of long-term or custodial care services designed to minimize or compensate for the loss of functioning due to age, disability or chronic illness.[126] LTC has many surface similarities to long-term disability insurance. There are at least two fundamental differences, however. LTC policies cover the cost of certain types of chronic care, while long-term-disability policies replace income lost while the policyholder is unable to work. For LTC, the event triggering benefits is the need for chronic care, while the triggering event for disability insurance is the inability to work.[123]

A number of alternatives to the public option were proposed in the Senate. Instead of creating a network of statewide public plans, Senator Olympia Snowe proposed a "trigger" in which a plan would be put into place at some point in the future in states that do not have more than a certain number of private insurance competitors. Senator Tom Carper has proposed an "opt-in" system in which state governments choose for themselves whether or not to institute a public plan. Senator Chuck Schumer has proposed an "opt-out" system in which state governments would initially be part of the network but could choose to avoid offering a public plan.[35]


Health insurance premiums have risen dramatically over the past decade. In the past, insurers would price your health insurance based on any number of factors, but after the Affordable Care Act, the number of variables that impact your health insurance costs have been reduced dramatically. We conducted a study to look at how health insurance premiums vary based on these characteristics. In our data we illustrate these differences by using an example 21 year old. Older consumers will see higher rates with 30 year olds paying 1.135 times more, 40 year olds paying 1.278 times more, 50 year olds paying 1.786x and 64 year olds paying 2.714 times the cost listed.

As the population covered by Medicare grows, its costs are projected to rise from slightly over 3 percent of GDP to over 6 percent, contributing substantially to the federal budget deficit.[47] In 2011, Medicare was the primary payer for an estimated 15.3 million inpatient stays, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States.[12] The Affordable Care Act took some steps to reduce Medicare spending, and various other proposals are circulating to reduce it further.
Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II.[20] The labor market was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers.[20]

Over time, the operations of many Blue Cross and Blue Shield operations have become more similar to those of commercial health insurance companies.[101] However, some Blue Cross and Blue Shield plans continue to serve as insurers of last resort.[102] Similarly, the benefits offered by Blues plans, commercial insurers, and HMOs are converging in many respects because of market pressures. One example is the convergence of preferred provider organization (PPO) plans offered by Blues and commercial insurers and the point of service plans offered by HMOs. Historically, commercial insurers, Blue Cross and Blue Shield plans, and HMOs might be subject to different regulatory oversight in a state (e.g., the Department of Insurance for insurance companies, versus the Department of Health for HMOs). Today, it is common for commercial insurance companies to have HMOs as subsidiaries, and for HMOs to have insurers as subsidiaries (the state license for an HMO is typically different from that for an insurance company).[19][95][103] At one time the distinctions between traditional indemnity insurance, HMOs and PPOs were very clear; today, it can be difficult to distinguish between the products offered by the various types of organization operating in the market.[104]


The US has a joint federal and state system for regulating insurance, with the federal government ceding primary responsibility to the states under the McCarran-Ferguson Act. States regulate the content of health insurance policies and often require coverage of specific types of medical services or health care providers.[54][55] State mandates generally do not apply to the health plans offered by large employers, because of the preemption clause of the Employee Retirement Income Security Act.
The blurring of distinctions between the different types of health care coverage can be seen in the history of the industry's trade associations. The two primary HMO trade associations were the Group Health Association of America and the American Managed Care and Review Association. After merging, they were known as American Association of Health Plans (AAHP). The primary trade association for commercial health insurers was the Health Insurance Association of America (HIAA). These two have now merged, and are known as America's Health Insurance Plans (AHIP).

The Affordable Care Act dramatically expanded Medicaid. The program will now cover everyone with incomes under 133% of the federal poverty level who does not qualify for Medicare, provided this expansion of coverage has been accepted by the state where the person resides. Meanwhile, Medicaid benefits must be the same as the essential benefit in the newly created state exchanges. The federal government will fully fund the expansion of Medicaid initially, with some of the financial responsibility gradually devolving back to the states by 2020.

Health insurance programs allow workers and their families to take care of essential medical needs. A health plan can be one of the most important benefits provided by an employer. The Department of Labor's Health Benefits Under the Consolidated Omnibus Budget Reconciliation ACT (COBRA) provides information on the rights and protections that are afforded to workers under COBRA.
Our health benefit plans, dental plans, vision plans, and life insurance plans have exclusions, limitations and terms under which the coverage may be continued in force or discontinued. Our dental plans, vision plans, and life insurance plans may also have waiting periods. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker.
×