Health Insurance

Navigating Health Insurance

Section Leaders: Dr. Christopher Steele, MD MPH MS, and Emma Kryzanski

Introduction:

The United States does not have a nationally based universal health care program. As a result, there health care is a major expense for most Americans. There is, however, a system of health insurance in the United States to help mitigate health care costs. Health insurance is a contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.9 Based on risk pooling, health insurance systems provide access to health care while spreading the risk of financial loss across all of their contributors.1 

Approximately 13%, or about 1 in 8 people within the United States did not have health insurance in 2013.1 Being uninsured has shown to be associated with increased risk for delaying or foregoing needed health care.1 Having a direct relationship with patients and patients’ health, medical professionals have a unique opportunity to combat lack of insurance within the United States.

The goal of this module is to introduce the health care insurance system within the United States and the current legislation that governs it, describe the implications of underinsurance on someone’s health, and demonstrate how to find and compare health insurance plans.

 

Learning Objectives

By the end of this module, learners will be able to do the following:

  1. Describe different forms of health insurance that are available in the United States.
  2. Review the practices implemented by current health insurance policy, including the Affordable Care Act.
  3. Discuss the implications of underinsurance and lack of insurance on an individual’s health and health care.
  4. Compare and recommend insurance plans based on a patient’s preferences and limitations.

 

Content Materials

  1. E. Kryzanski Health Insurance in the United States
  2. E. Kryzanski Navigating Health Insurance Options
  3. Kominski GF, Nonzee NJ, Sorensen A. The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations. Annu Rev Public Health. 2017;38:489-505. doi:10.1146/annurev-publhealth-031816-044555 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886019/ 
  4. Artiga S, Diaz M. Health coverage and care of undocumented immigrants. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/. Published July 15, 2019. Accessed July 26, 2021.https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/

 

Resources for Patients and Providers

 

Optional Reading Materials

  • Forrest CB, Hawkins JE, Whelan E-M, King TE, Wheeler MB. Chapter 3: Financing and Organization of Health Care for Vulnerable Populations. In: Medical Management of Vulnerable and Underserved Patients: Principle, Practice, and Populations. 2nd ed. McGraw Hill; 2016:25-33.
  • McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. Milbank Q. 2009;87(2):443-494. doi:10.1111/j.1468-0009.2009.00564.x
  • Sanchez GR, Sanchez-Youngman S, Murphy AA, Goodin AS, Santos R, Valdez RB. Explaining public support (or lack thereof) for extending health coverage to undocumented immigrants. J Health Care Poor Underserved. 2011;22(2):683-699. doi:10.1353/hpu.2011.0043

 

References

  1. Forrest CB, Hawkins JE, Whelan E-M, King TE, Wheeler MB. Chapter 3: Financing and Organization of Health Care for Vulnerable Populations. In: Medical Management of Vulnerable and Underserved Patients: Principle, Practice, and Populations. 2nd ed. McGraw Hill; 2016:25-33.
  2. McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. Milbank Q. 2009;87(2):443-494. doi:10.1111/j.1468-0009.2009.00564.x
  3. Sanchez GR, Sanchez-Youngman S, Murphy AA, Goodin AS, Santos R, Valdez RB. Explaining public support (or lack thereof) for extending health coverage to undocumented immigrants. J Health Care Poor Underserved. 2011;22(2):683-699. doi:10.1353/hpu.2011.0043
  4. Kominski GF, Nonzee NJ, Sorensen A. The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations. Annu Rev Public Health. 2017;38:489-505. doi:10.1146/annurev-publhealth-031816-044555
  5. Artiga S, Diaz M. Health coverage and care of undocumented immigrants. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-and-care-of-undocumented-immigrants/. Published July 15, 2019. Accessed July 26, 2021.
  6. Glossary of Health Coverage and Medical Terms. CMS. https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/uniform-glossary-final.pdf. Accessed August 7, 2021.
  7. 2021 Poverty Guidelines. ASPE. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2021-poverty-guidelines. Accessed August 7, 2021. 
  8. Medicaid, children's health insurance program, & basic health Program eligibility levels. Medicaid.gov. https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels/index.html. Published July 1, 2021. Accessed August 7, 2021. 
  9. Health insurance - HEALTHCARE.GOV GLOSSARY. HealthCare.gov. https://www.healthcare.gov/glossary/health-insurance/. Accessed August 8, 2021.