Insurance plans with higher out-of-pocket costs generally have smaller monthly premiums than plans with low deductibles. When shopping for plans, individuals must weigh the benefits of lower monthly costs against the potential risk of large out-of-pocket expenses in the case of a major illness or accident. Health insurance has many cousins, such as disability insurance, critical (catastrophic) illness insurance, and long-term care (LTC) insurance.
Prior to the ACA as of 2007, about 9% of Americans were covered under health insurance purchased directly,[53] with average out-of-pocket spending is higher in the individual market, with higher deductibles, co-payments and other cost-sharing provisions.[72][89][90] While self-employed individuals receive a tax deduction for their health insurance and can buy health insurance with additional tax benefits, most consumers in the individual market do not receive any tax benefit.[91]

Cost assistance is available to help lower the monthly expense of health insurance. Know as a tax credit or tax subsidy, federal money helps those that make between 100%-400% of the Federal Poverty Level. (For an individual that is between $11,770 – $47,080, depending on the state.) With cost assistance, individuals paid an average of less than $100 a month for a plan on the marketplace in 2015. That is a $268 savings each month.


The US health insurance market is highly concentrated, as leading insurers have carried out over 400 mergers from the mid-1990s to the mid-2000s (decade). In 2000, the two largest health insurers (Aetna and UnitedHealth Group) had total membership of 32 million. By 2006 the top two insurers, WellPoint (now Anthem) and UnitedHealth, had total membership of 67 million. The two companies together had more than 36% of the national market for commercial health insurance. The AMA has said that it "has long been concerned about the impact of consolidated markets on patient care." A 2007 AMA study found that in 299 of the 313 markets surveyed, one health plan accounted for at least 30% of the combined health maintenance organization (HMO)/preferred provider organization (PPO) market. In 90% of markets, the largest insurer controls at least 30% of the market, and the largest insurer controls more than 50% of the market in 54% of metropolitan areas.[116] The US Department of Justice has recognized this percentage of market control as conferring substantial monopsony power in the relations between insurer and physicians.[117]
Still, private insurance remained unaffordable or simply unavailable to many, including the poor, the unemployed, and the elderly. Before 1965, only half of seniors had health care coverage, and they paid three times as much as younger adults, while having lower incomes.[28] Consequently, interest persisted in creating public health insurance for those left out of the private marketplace.
3) The insurance company will then review your application and you can receive an update within 24 hours on whether you are approved; though in some cases you may receive a status update or request for further information instead. Depending on whether the insurance company needs more information, when you submit your application or other conditions, some exceptions may apply.
Public polling consistently showed majority support for a public option. A July 2009 survey by the Quinnipiac University Polling Institute found that 28% of Americans would like to purchase a public plan while 53% would prefer to have a private plan. It also stated that 69% would support its creation in the first place.[42] Survey USA estimated that the majority of Americans (77%) feel that it is either "Quite Important" or "Extremely Important" to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance" in August 2009.[43] A Rasmussen Reports poll taken on August 17–18 stated that 57% of Americans did not support the current health care bill being considered by Congress that did not include a public option,[44] a change from their findings in July 2009.[45] A NBC News/Wall Street Journal poll, conducted August 15–17, found that 47% of Americans opposed the idea of a public option and 43% expressed support.[46] A Pew Research Center report published on October 8, 2009 stated that 55% of Americans favor a government health insurance plan to compete with private plans. The results were very similar to their polling from July, which found 52% support.[47] An October 2009 Washington Post/ABC poll showed 57% support,[48] a USA Today/Gallup survey described by a USA Today article on October 27 found that 50% of Americans supported a government plan proposal,[49] and a poll from November 10 and 11 by Angus Reid Public Opinion found that 52% of Americans supported a public plan.[50] On October 27, journalist Ray Suarez of The News Hour with Jim Lehrer noted that "public opinion researchers say the tide has been shifting over the last several weeks, and now is not spectacularly, but solidly in favor of a public option."[51]

In-network and out-of-network providers – some plans cover different costs from in-network, versus out-of-network, providers. In-network providers are those who agree to the health insurer’s policies and procedures and typically result in less expense to the insured. Out-of-network providers are those providers that have not yet agreed fully to the health insurer’s policies and procedures. The insurer typically cover less expense or no expense at all for out-of-network providers.
Marcia Angell, M. D., Senior Lecturer in the Department of Social Medicine at Harvard Medical School and former Editor-in-Chief of the New England Journal of Medicine, believes that the result of a public option would be more "under-55's" opting to pay the fine rather than purchase insurance under a public option scenario, instead advocating lowering the Medicare age to 55.[40]
Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government.[1] Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
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