Ginger Kuenzel about life in small-town America
Stimmt es, dass die meisten Us-amerikaner keine Krankenversicherung haben? Unsere Kolumnistin erklärt, wie das Versicherungssystem funktioniert.
While one might occasionally hear horror stories about people in the US who have spent their life savings on medical bills, that’s now the exception to the rule — thanks to President Obama’s Affordable Care Act (ACA).
That law put requirements in place to make health insurance more affordable. In the past, people with cancer, for example, might be denied insurance coverage simply because they had a pre-existing condition. Today, this is illegal, and the government now also specifies a maximum annual sum that people have to pay themselves on medical expenses. After this, their insurance company pays 100 percent of all other covered services that year. Also, under the ACA, insurance companies can no longer cap the total amount they will pay out during a person’s lifetime.
Despite this progress, the US is still the only industrialized country without universal health care. However, most people have some form of health insurance, which can include the following:
Employer plans: Employers with full-time employees aged 50+ must provide them with health insurance. Employer and employee share the cost of the premiums (employers generally pay the larger share).
Government programs: Medicaid and the Children’s Health Insurance Program (CHIP) provide low-cost or free health insurance to low-income individuals and families, paid for by the government. The Medicare program, launched in 1965, for workers aged 65+ (including the self-employed) is funded by payroll deductions.
Other insurance plans: Those who are not covered by the above options can buy insurance, using the government’s health-care exchange. This is part of the ACA and provides a selection of private plans that follow government standards. Based on their income, some people qualify for a government subsidy to help pay their premiums.
Insurance premiums can be costly. The more you pay, the more extensive and flexible your coverage will be. But there are ways to keep costs down. I keep my premiums low by having a PPO (preferred provider organization) plan. If I visit a health-care provider that is in my PPO network, I incur only a small charge (known as a “co-pay”) at the time of my visit. If I go outside my network, my co-pay is higher.
Some plans also have a deductible: the part of your medical expenses that you must pay each year before your insurance kicks in. However, preventive-care visits — such as a regular checkup, mammogram, colonoscopy, and some vaccines — are free.
My policy also pays for my gym membership. After all, if I stay healthy, I may be less likely to require expensive care in the future. It’s a win-win situation — for them as well as for me.