Healthcare Insurance in the U.S.

The United States is alone among developed nations with the absence of a universal healthcare system. Current estimates put U.S. healthcare spending at approximately 16% of GDP. This is the second-highest among all United Nations member nations. Insurance is provided by large-risk bearing corporate entities. They organize healthcare delivery by negotiating pricing and services with providers (physicians and hospitals). Most Americans under age 65 (59.3%) receive their health insurance coverage through an employer. These include private and civilian public-sector employers. The percentage of people under group coverage is declining.

Healthcare in the United States is provided by many separate legal entities. The majority of facilities are largely owned and operated by the private sector. Health insurance is now primarily provided by the government in the public sector.

U.S. Health Insurance System

Public: Medicare

Medicare is the federal government program that provides health insurance if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). Medicare is controlled by the Centers for Medicare & Medicaid Services (CMS). The program is funded in part by Social Security and Medicare taxes you pay on your income. It is also partly funded through premiums that people with Medicare pay, and in part by the federal budget.

Private Health Insurance

Private health insurance refers to any health insurance coverage that is not offered by a state or federal government. Instead, private health insurance is offered by a private entity, such as an insurance company or broker. There are a number of private health insurance options available. This can include:

  • Federal or state marketplace plans
  • Health insurance offered through an employer (such as a group health plan)
  • Private health insurance plans offered by licensed brokers or agents
  • Some private health insurance plans have benefits that meet the minimum essential coverage requirements of the Affordable Care Act (Obamacare).
  • Other types of private health insurance options, such as catastrophic coverage, may offer different benefits but may not count as a qualified health plan.