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 What is health insurance?

What is health insurance?
state of mn employee health insurance

Health insurance is a type of insurance coverage that covers the cost of medical and surgical expenses for the insured individual.

Insurance companies use the term "service provider" to describe a clinic, hospital, physician, laboratory, healthcare practitioner, or pharmacy that treats an individual. 

The “insured” is the holder of the health insurance policy or the holder of health insurance coverage.

Depending on the type of health insurance coverage, either the insured pays the costs out of pocket and receives compensation, or the insurance company pays directly to the provider.

In countries that do not have universal health care coverage, such as the United States, health insurance is commonly included in employer benefit packages.

In the United States, the number of people with insurance decreased from 44 million in 2013 to less than 28 million in 2016, according to the Kaiser Family Foundation. Researchers attribute this to recent changes in legislation.

A 2011 Commonwealth Fund Report reported that a quarter of all working-age United States citizens experience a health insurance coverage gap. Numerous individuals in the study lost their medical coverage when they became jobless or changed positions.

The level of treatment in emergency departments varies greatly depending on the type of health insurance a person has.

What is Health insurance types?

There are two main types of health insurance:

Private Health Insurance: The Centers for Disease Control and Prevention (CDC) says that the health care system in the United States relies heavily on private health insurance. In the National Health Interview Survey, researchers found that 65.4 percent of people under the age of 65 in the United States have some type of private health insurance coverage.

Public or state health insurance: In this type of insurance, the state subsidizes health care in return for a premium. Medicare, Medicaid, Veteran's Health Administration, and Indian Health Service are examples of public health insurance in the United States.

Other kinds

People also define the insurance company the way they manage their plans and communicate with healthcare providers.

Managed Care Plans: In this type of plan, the insurance company will have contracts with a network of healthcare providers to provide low-cost medical care to policyholders. There will be fines and additional costs added to hospitals and clinics outside the network, but they will save some treatment.

The more costly the approach, the more adaptable it is with the emergency clinic organization.

Compensation or fee-for-service plans: The fee-for-service plan covers treatment equally among all healthcare providers, allowing the insured to choose their preferred treatment location. The insurance company will typically pay at least 80 percent of the costs in a compensation plan, with the patient paying the remaining costs as co-insurance.

Health Maintenance Organizations (HMOs): These are the organizations that provide medical care directly to the insured. The policy usually has a dedicated primary care physician who coordinates all necessary care.

The HMOs will usually only fund treatment that is referred by this GP, and will have a negotiated fee per medical service to reduce costs. This is usually the cheapest type of plan.

Preferred Provider Organizations (PPOs): PPO is similar to a compensation scheme, in that it allows the insured to visit any doctor they prefer.

PPO also has a network of certified service providers with whom they have negotiated costs.

The insurance company will pay less for treatment with out-of-network providers. However, people on a PPO can self-refer to specialists without needing to visit a primary care doctor.

Point of Service (POS) plans A Point of Sale plan works as a combination of HMO and PPO. The insured can choose between coordinating all treatments with a primary care physician, receiving treatment within the insurance company's network, or using providers outside the network. The sort of plan will decide the advancement of the treatment.

Why is the type of insurance plan important?

The type of plan determines how an individual will handle the treatment they need and how much money they will need to pay per day.

In 2003, the US Congress introduced a new option, the Health Savings Account (HSA). It's a combination of HMO, PPO, compensation plan, and savings account with tax benefits. 

However, the policyholder must pair this type with an existing health plan that has a deduction of over $ 1,100 for individuals and $ 2,200 for families.

HSAs can increase coverage, extending existing plans to cover a wider range of treatments. If the HSA is paid by the employer on behalf of their employees, the payments are tax-deductible. 

One can build money in HSA while they are healthy and save for cases of poor health later in life.

However, people with chronic illnesses, such as diabetes, may not be able to save a substantial amount in their health insurance account as they regularly have to pay exorbitant medical costs to manage their health concerns.

These plans often carry a very high deductible, which means that although the premiums can be lower, people often end up paying the full expenses of any medical treatment needed.

There is more cover as the kinds of plans develop. The differences between the types of politics became more blurred.


Most compensation plans use managed care techniques to control costs and ensure that there are sufficient resources to pay for appropriate care. Likewise, many managed care plans have adopted some characteristics of fee-for-service plans.