Healthcare A Beginner’s Guide


Healthcare. It’s an issue that affects a great deal of Americans, as the individual mandate in the American Care Act tried to force people to buy insurance, with the consequence a financial penalty if they didn’t have any. Though it could mean through an employer, millions of Americans who get their insurance through the marketplace.

But even that was tricky and difficult. Americans were forced to choose between numerous plans, all of which had their own characteristics, and it was difficult for Americans to decipher those plans. The issue became about the terminology. People asked themselves, “What is a deductible?” Or, “What is co-insurance?” Or even, “What is a formulary?”

These were all questions on the minds of Americans as they navigated the healthcare insurance marketplace. They learned over time, or maybe they didn’t. This is the focus of the article.

There are some statistics surrounding health insurance that are worth noting. They are:

  • According to the CDC, there were 28.6 million people without healthcare insurance in the U.S. in 2016.
  • Every single day, around 10,000 Americans (ages 65+) enroll in Medicare for the first time.
  • According to the Bureau of Labor Statistics, 85% of full-time workers and 19% of part-time workers (in the private sector) had access to medical care benefits as of March 2017.
  • By 2050, it is anticipated that Americans aged 65 or older will number nearly 89 million people, which is more than double the number of older adults in the U.S. in 2010.
  • According to Glassdoor?s 2015 Employment Confidence Survey, 60% of people report that benefits are a major factor in considering whether to accept a job offer.
  • Two in five Americans under 65 have employer-based healthcare coverage. (Gallup, January 2015)

Healthcare is important, in that it provides a level of security if someone were to get sick, or go to the hospital, or face a seemingly too high amount of medical bills. But there is a confusing aspect to healthcare for some, with many terms being thrown around that make people wonder what they are. Here is a quick guide to those definitions.

The healthcare deductible is the same as a car insurance deductible: It is the amount a person pays before insurance coverage kicks in. For some healthcare plans, the deductible is just a couple hundred dollars. For others, it’s over a thousand dollar. A great deal just depending on the health insurance plan.

Generally, plans with a higher premium will have a lower deductible than plans with a lower premium. A premium is the amount a person pays monthly to have health insurance. It is like a monthly payment on a car or the gym. It makes sure the coverage stays active. The difference between the high deductible and the low deductible is simple.

Generally, people who are not at risk of serious illnesses will choose a lower premium plan. These are called “catastrophic” plans. They are good for people whose only medical expenses will likely be in a catastrophe. Those with higher premium plans, the “gold” plans on the marketplace, are more likely to get sick.

Co-insurance is a term that throws people off. While co-pays are generally easy to understand (they are the cost paid per visit to a doctor or specialist or for medication), co-insurance involves the percentage cost of treatment. A co-insurance of 50% for medication means that the insurance company will pick up 50% of the cost.

This can put individuals in a lurch, where they have to pick up 50% of the cost of an expensive medication. This holds true for co-insurance for doctor’s visits, general treatment, and more. The cost of these things with co-insurance can become expensive. This is difficult for those who have health issues.

There are terms worth noting here. They are open enrollment, Medicare supplement insurance, medical insurance plans, insurance benefits, health insurance plans, health care plans, group disability insurance, group health insurance plans, Cobra health insurance, employer group health plans, and more.

Health care plans can be varied in the deductibles, the co-pays, and the co-insurance that each have. Health care plans in the marketplace were supposed to be inclusive; a lot of plans with a lot of choices offered. Unfortunately, health care plans in many areas are no longer inclusive. Health care plans are good for Americans who have health issues.