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The Many Faces of Health Insurance

One of the most widely publicized and hotly debated forms of insurance in America today, health insurance is the subject of intense political and social debate. A rapidly evolving and extremely complex subject, health insurance is also one of the most important benefits offered by many employers.

Types of Insurance

• Medical Insurance typically covers and specifies payment levels for doctor visits and treatment, medications, hospital stays, emergency room visits, surgical treatment, and so forth. There are wide variations in coverage plans, with numerous combinations of covered and excluded items, different coverage levels, deductible amounts, and other variables that make it impossible to offer a general statement regarding all coverage plans. Many employers offer an open enrollment period annually, during which employees may select from different coverage plans. Careful selection of the appropriate plan for each individual is a critical task.
• Dental Insurance is sometimes included in medical plans, but more often it is a separate policy. Virtually all dental plans cover annual or semi-annual cleanings and check-ups, with many plans increasing the covered percentage with regular appointment attendance over time. Routine treatments such as cavity fillings, bridges, and the like, are also typically covered, though the amount of coverage can vary. Braces are sometimes covered for minor dependents, and more rarely for adults. Cosmetic procedures are typically not covered.
• Vision insurance is often offered as a separate plan to go along with medical insurance. Vision plans typically cover an annual check-up, with glasses or contacts covered to a pre-determined limit every year or two. Necessary medical procedures to protect or correct eye health are usually covered. At this time LASIK or other corrective procedures are rarely covered.

Managed Care

One of the biggest trends in medical insurance over the past two decades in the United States has been the rise of managed care as a primary delivery model for medical care. Based on the concept of centralized decision making, pooled resources, and efficient delivery of services, Health Management Organizations, or HMOs, do offer economical coverage, often at much lower premiums than privately managed insurance plans. Critics, however, point to longer wait times for appointments, fewer physicians from which to choose, and often the need for specialist referrals as weaknesses of the HMO mode. Regardless of the advantages or disadvantages of HMOs, it seems certain that this organizational model will continue to grow in popularity.

Medicare and Medicaid

The United States government has, for many years, funded two particular programs to help extend medical coverage to individuals who may not be able to otherwise access the necessary health care. Medicare is designed to help elderly Americans pay for their health care. More recently, the Medicare Part D program was set up to help the elderly pay for prescription drugs. Medicaid is intended to help impoverished Americans obtain health care; however, with high administrative costs, low reimbursement rates, and an often complicated set of restrictions and requirements, the number of physicians who accept Medicaid has decreased steadily over the past several years.

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