Major Medical
Private Health Insurance
Private health insurance is a type of health coverage offered by private companies, as opposed to being funded by the government. It typically requires individuals or employers to pay premiums in exchange for coverage of medical services.
Private health insurance plans can vary widely in terms of coverage, including services such as doctor visits, hospital stays, prescription drugs, and preventive care. They often have features like deductibles, co-payments, and out-of-pocket maximums. These plans may be obtained through employers, purchased directly by individuals, or provided through marketplaces established by health reform initiatives like the Affordable Care Act (ACA) in the U.S.
Self-Insured Plans
Self-funded health insurance plans (also known as self-insured plans) are health coverage plans where an employer assumes the financial risk of providing health benefits to its employees. Instead of paying premiums to an insurance company, the employer sets aside funds to directly cover employees’ medical expenses.
Key features include:
- Cost control: Employers have more flexibility to design benefits and manage costs.
- Third-party administration: Employers often hire a third-party administrator (TPA) to handle claims processing and administrative tasks.
- Stop-loss insurance: Employers may purchase stop-loss insurance to protect against unexpectedly high claims.
These plans are typically used by larger organizations that can manage the financial risk, but smaller companies may also use them with appropriate risk management measures.
HealthCare.Gov
HealthCare.gov is the official health insurance marketplace in the United States, created under the Affordable Care Act (ACA). It allows individuals, families, and small businesses to shop for, compare, and enroll in health insurance plans.
Key features of HealthCare.gov include:
- Access to Subsidies: Many users qualify for financial assistance, such as premium tax credits and cost-sharing reductions, to make insurance more affordable.
- Standardized Coverage: All plans offered must cover essential health benefits, including preventive care, prescription drugs, and hospitalization.
- Open Enrollment Periods: Coverage can typically be purchased during designated enrollment periods or through Special Enrollment Periods triggered by qualifying life events (e.g., marriage, job loss).
The platform is designed to make health insurance accessible to those without employer-sponsored coverage or other forms of insurance.
Telehealth
Telehealth plans are health insurance options or add-ons that provide coverage for medical services delivered remotely through technology, such as video calls, phone calls, or online messaging. These plans allow individuals to consult healthcare professionals without needing in-person visits.
Key features include:
- Convenience: Access to medical care from home or any location with an internet connection.
- Coverage for Common Services: Often includes primary care, mental health counseling, chronic condition management, and minor urgent care.
- Cost-Effectiveness: Typically involves lower copayments or fees compared to in-person visits.
Telehealth plans are often part of broader health insurance policies and have grown in popularity due to their accessibility and efficiency, especially during the COVID-19 pandemic.