Health Care Coverage: Private Insurance and Expanding Coverage

Background

Most Americans rely on health insurance to help pay for their health care, and most who are younger than age 65 obtain coverage through the private insurance market.

The majority of people age 50–64 have health insurance coverage through their employer, although the share of people with such coverage has been declining. Prior to the 2010 Affordable Care Act ( ACAThe ACA—the shortened abbreviation for the  Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. ), 50- to 64-year-olds often had difficulty obtaining health care coverage if they did not have access to it through their employer. The ACAThe ACA—the shortened abbreviation for the  Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. has provided new opportunities for health coverage for this population through health insurance benefit exchanges, as well as through MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.  (see this chapter: Expanding Health Care Coverage).

Some Americans have private retiree health coverage through former employers. In addition, many beneficiaries in traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… purchase private MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). supplement (Medigap) policies to supplement their MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). coverage.

Historically, the primary goals of health care reform efforts have been to ensure that everyone has access to affordable health care coverage and to provide adequate protection from health care costs. Reform efforts have included changes to the practices of private insurers.

Found in Health Care Coverage: Private Insurance and Expanding Coverage