Despite its importance for countering the catastrophic CO VID-19 outbreak, the nation’s lack of proper health insurance coverage is an extremely serious economic issue. Since most of the United States population relies on employer sponsored health insurance (ESI) to cover health care costs, any significant economic blow that destroys jobs also erodes access to health insurance. The current trend toward for-profit insurance markets has resulted in insurance companies that charge excessive rates and provide poor health care coverage. As a result, tens of millions of low income and middle class households in the United States either have no health insurance at all or very limited health insurance coverage that has gaps or severe negative effects on their health and financial well-being.
One out of every fifty American adults lacks proper health insurance coverage because they are not employed, are self-employed, ineligible for government health assistance programs, or live in poverty. Health care emergencies are the leading reason people visit emergency rooms. For this reason, health insurance has become a major concern for Americans. Without health insurance coverage, many persons would have to pass on essential health services that could have otherwise been paid for by their employer. Without health insurance, persons with serious health conditions would not be able to afford quality health care.
Millions of persons who would otherwise be able to afford health insurance now cannot because their employer-sponsored health insurance policy has become less affordable, or has expired. One in five workers lost his job during the recent economic crisis. One of the ways an insurance company can keep medical costs down is to reduce the number of people they insure through their company-sponsored plan. For employers, reducing health insurance coverage means reducing the amount of money they are required to contribute toward each employee’s health insurance premium. For employees, reducing their insurance coverage means foregoing medical benefits that might otherwise be available to them through their employer’s health insurance plan.
Most employers offer some type of group health insurance coverage, usually as part of an employee’s benefits package. The problem comes when the group plan is canceled for some reason, including discontinued operations, merger negotiations, employee strike, and other related circumstances. To continue to pay for insurance, many persons must buy it as a stand-alone policy. This can be expensive and difficult.
In addition, insurance purchased as a stand-alone policy may not cover all of a person’s medical bills. A person can buy a separate rider to cover him or herself if the original policy will not cover a specific illness or medical problem. These “add ons” must be purchased from the insurance company and will raise the premiums of the overall insurance plan. In addition, adding riders makes the insurance company liable for any death or injury that occurs while a person is covered under the policy.
Many insurance companies offer an HMO (health maintenance organization) or PPO (preferred provider organization) program. These plans combine several different insurance options into one. For example, an individual who gets health insurance through an employer or the equivalent can choose to have a group plan through the insurance company. Then, if they need additional health insurance, they can choose an HMO or PPO. If a person leaves a company and decides to buy health insurance independently, he or she will still be covered by the insurance company’s “existing policies.”
An HMO or PPO policy will provide the insured with the lowest monthly premium, but it won’t cover any medical expenses for the first six months. The insured has to buy insurance from the insurance company during this time, at a cost that may be higher than if the individual had purchased insurance individually. Both HMO and PPO plans will have restrictions on what treatments the insured can receive and at what costs. Some plans will require prior approval for most elective procedures.
There are other ways to purchase insurance coverage. One way is to go through an insurance company directly. This is the most expensive way to get insurance because the insurance company will usually require a credit check and other personal information. Another option is to use an insurance brokerage firm. With an insurance brokerage firm, a person can shop for insurance without having to make a single sale.