Please discuss the reasons for having health insurance coverage.

  1. Please discuss the reasons for having health insurance coverage.
  2. Are there individuals who choose not to be covered by health insurance; and why?
  3. Why are there copays? Are they necessary? How are they determined?
  4. Are different levels to health care insurance truly necessary?

Must respond to 3 classmates after

Student 1

Alexander Amoah

Please discuss the reasons for having health insurance coverage.

Health insurance is a contract between an individual and an insurance company. The individual buys a plan, and the company agrees to pay part of your medical costs when you get sick or hurt. In my opinion, the number one reason for having a health insurance coverage deals with finances. According to health care .gov, no one plans to get sick or hurt, but almost everyone needs medical care at some point. Health insurance is there to covers costs and offers many other important benefits. Health insurance protects individual from unexpected, high medical costs. The expenses incurred after a surgery, the death of a loved one, or a disability are beyond any savings a person may have accumulated, and it is for this reason that insurance is such an importantcomponent of your financial planning.

Are there individuals who choose not to be covered by health insurance; and why? 

As I said in the earlier, the number one reason why some people choose not to be covered by health insurance is that, they think that a fine can be cheaper than paying your insurance premium. Others on the other hand, some people decide not to obtain insurance precisely because they expect not to need medical care or they just flat out cannot afford medical insurance.

Why are there copays? Are they necessary? How are they determined?

A health insurance copayment is a fixed amount established by an insurance plan for sharing the cost of certain health services between the insurance plan and the insurance customer. The insurance company sets a cost for different services with a network of doctors. The doctors that contract with the health insurance company are considered in-network doctors. The insured person will only pay the smaller copayment when he or she has a service with an in-network doctor.

Copays are determined by balancing the needs of the patient with the financial needs of their insurance company. Also, the type of plan the individual has with the insurance company plays a big role determining the amount the individual will copay.

      Are different levels to health care insurance truly necessary?

I believe everyone should have a higher level of health care but it’s not always so because of individual’s financial strength. It’s almost as if one can have a higher level of health care based on how much money they can pay after their health care plan has paid its part.

 

REFERENCE

 

Marketplace.cms.gov. (2018). [online] Available at: https://marketplace.cms.gov/outreach-and-education/value-of-health-insurance-english.pdf [Accessed 18 Sep. 2018].

 

HealthCare.gov. (2018). See How Health Insurance Coverage Protects You. [online] Available at: https://www.healthcare.gov/why-coverage-is-important/coverage-protects-you/ [Accessed 18 Sep. 2018].

 

Fin24. (2018). Why insurance is important. [online] Available at: https://www.fin24.com/Money/Insurance/Why-insurance-is-important-20140414 [Accessed 18 Sep. 2018].

 

Student 2

Talisha Adams

Health insurance is important because coverage helps people get timely medical care and improves their lives and overall health. Prevention is known to be better than cure, so by having health insurance preventative measures can be taken so as to ensure patients are healthy and safe. In the event a problem does arise it can be treated early giving that patient a better chance of survival. Although the world ranks the U.S. as the most powerful nation economically, it is the only industrialized nation worldwide which does not provide universal health care coverage. For this reason some people choose not to have health insurance coverage. Overall, uninsured people get about half as much care as their privately insured counterparts. Some uninsured people may decide not to obtain insurance precisely because they expect not to need medical care or they just flat out cannot afford medical insurance. Full implementation of the ACA will reduce the number of Americans who are uninsured and significantly increase the rate of enrollment on Medicaid by the 15 million uninsured persons. The law will ensure that 94 percent of the US population can access health insurance coverage by the consequent reduction in the proportion of the uninsured.

Why are there copays?  Insurance companies use copayments to share health care costs to prevent what they consider moral hazard. Though the copay is often a small portion of the actual cost of the medical service, it is meant to prevent people from seeking medical care that may not be necessary (e.g., an infection by the common cold). Consumers may feel that copays are highly unnecessary especially those with large copays but for insurance companies it is a preventive measure for people to not over use their policies. The underlying philosophy is that with no copay, people will consume much more care than they otherwise would if they were paying for all or some of their medical care expenditures. However, copays may also discourage people from seeking necessary medical care and higher copays may result in non-use of essential medical services and prescriptions, thus rendering someone who is insured effectively uninsured because they are unable to pay higher copays. Copays are determined by balancing the needs of the patient with the financial needs of their insurance company. A copay must be high enough that it will discourage insureds from pursuing unnecessary medical care, but it must be low enough to be affordable so as not to prevent the patient from getting necessary treatments.

Are different levels to health care insurance truly necessary? Apparently different levels to health care insurance is necessary due to everyone’s income brackets and specific health care needs. Personally I do not believe different levels of health care insurance is necessary. There are four Metal Levels of standardized coverage. They are represented by their actuarial value. They are known as a percentage of benefits paid by the patient and by the health plan providers. Details of these plans are as follows:

· Bronze: 60% paid by the health plan and 40% paid by the individual

· Silver: 70% paid by the health plan and 30% paid by the individual

· Gold: 80% paid by the health plan and 20% paid by the individual

· Platinum: 90% paid by the health plan and 10% paid by the individual

These metal levels were created to meet the requirements of the Affordable Care Act (ACA) in 2015. They provide a strong indication of the percentage of what the individual will pay verses what the health plan will pay. Therefore depending on your income brackets you will know exactly how much out of pocket you would be able to afford.

 

 

 

Reference

Bovbjerg R. & Hadley J. (2007). Why Health Insurance is Important retrieved from: https://www.urban.org/sites/default/files/publication/46826/411569-Why-Health-Insurance-Is-Important.PDF

Student 3

Darrius Cooley

Health insurance is an extremely valuable commodity in our modern society that should be afforded to all. At present, the current health care system does not mandate individual healthcare, which in turn could impose increased financial strain on individuals who chose to purchase healthcare within the network. In fact, individuals below poverty are at the highest risk of being uninsured. In total, 8 in 10 of the uninsured were families with incomes below 400% of poverty in 2016.

This blistering statistic highlights one of the many reasons individuals sometimes chose to not purchase healthcare insurance. In this case, individual co-pays are used to offset the cost of health insurance. Co-pays are a fixed price financial asset that the insured individual must pay based on the terms of their healthcare policy. The services covered under these healthcare policies are often times extremely expensive and are based on individual healthcare needs.

As a matter of fact, health insurance companies require that doctors in the network charge individual co-pays at the time of their patient visits. In fact, your individual healthcare plan will determine the amount of your co-pay. In this case, co-pays can occur before and after paying your deductible. Since multiple levels of healthcare insurance exist within multiple healthcare networks, the choices can often seem overwhelming.

Despite this fact, healthcare costs continue to rise with only gradual changes in healthcare availability in our current health system. Therefore, a single payer system in our current healthcare network would provide an increased availability of care and cost savings benefits to the majority of those uninsured individuals in the healthcare network.

References

https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population

www.ncsl.org/research/health/state-ins-mandates-and-aca-essential-benefits.aspx

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