health insurance – Page 2 – watercress words by Dr Aletha

How to Pay for Medical Care: A Guide for Americans

In this post I review how people pay for their healthcare. In the U.S., medical care financing includes employer-provided insurance, Medicaid, Medicare, the Affordable Care Act, and COBRA. Eligibility for these programs varies based on income, age, and employment status. Additional financial assistance exists through Medicare Savings Programs and nonprofit organizations, helping manage medical bills and related expenses.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

Please do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with your physician or other qualified healthcare provider.

This content is for your “information and inspiration”, and does not imply my endorsement or recommendation.

How do you pay for your medical care?

We do not have “socialized” medicine or “universal” health care in the United States —or do we?

The government may not directly pay for healthcare but it is involved through taxes we pay and for tax deductions available for insurance premiums and certain medical expenses. Most people still pay out of pocket for at least some if not most of their healthcare.

Multiple sources confirm that at least half of the population is eligible for health insurance coverage through an employer. The rest may be eligible for coverage through one or more options discussed below.

Healthcare payment options

Government programs can help pay for medical care. Depending on the program, you may also be eligible for help with vision and dental care. Your income, age, employment status, and qualifying health issues will determine your eligibility. These programs include:

Medicaid and the Children’s Health Insurance Program (CHIP)

You may qualify for Medicaid or long-term, depending on your situation. These are both joint ventures of the federal and state governments so eligibility may differ depending on where you live. They may even have different names. In my state, Oklahoma, it’s called SoonerCare.

Unfortunately, Medicaid funding is in jeopardy due to proposed cuts in funding by Congress. Americans living in rural communities throughout the country could see their access to health care diminish if Congress changes eligibility for Medicaid or significantly reduces its federal funding.

Medicaid cuts rippling through rural America could bring hospital closures, job losses

Medicare

Everyone is eligible for Medicare at the age 65 years, and sometimes younger if you have a permanent disability. It may also depend on whether or not you are still covered under an employer-provided plan.

The Affordable Care Act (ACA) / Health Insurance Marketplace

This is still sometimes referred to as ObamaCare since Congress passed the act when he was president. The current president has said he intends to end it but so far it is still law. This basically covers people who don’t have insurance through an employer or qualify for Medicare.

Premiums for marketplace plans may increase if federal subsidies are allowed to expire.

Oklahomans using ACA health insurance plans could see higher premiums, official warns

Consolidated Omnibus Budget Reconciliation Act

You may think you have never heard of this but it is better known as COBRA. (yes, pronounced like the snake.) If you have a “qualifying life event” and are no longer employed, you may be able to continue on your employer’s insurance plan.

The catch is, you have to pay for it. Paying for this type of plan can be quite expensive, but may be necessary if you have medical issues that can’t be delayed. If you will soon start a new job offering a health plan it may be worth considering this temporarily.

Learn how these programs work, find out if you are eligible, and see how to apply.

Veterans and Military Healthcare

Those currently serving in the Armed Forces and their dependents can receive healthcare through the Tricare program of the Department of Defense.

Military Veterans can receive care through hospitals and clinics of the Veterans Administration Health systems. Dependents of some veterans, usually those with service-connected disabilities may be eligible for CHAMPVA-Civilian Health and Medical Plan.

Help with medical bills beyond insurance

Medicare Savings Programs

There are 4 Medicare Savings Programs that may be able to help with Part A and Part B premiums, deductibles, coinsurance, and copayments. You’ll apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for. Even if you don’t think you qualify, you should still apply.

Medicare Extra Help

This program can help you pay Medicare Part D costs that cover prescription drugs. Find out if you qualify for Extra Help and apply.

Financial Assistance Programs

If you still need help with medical bills after health insurance or Medicaid payments have been applied, a financial assistance program may assist you with the remaining costs. In most cases, you can apply through a doctor or hospital where you are seeking medical treatment.

Learn more about these options here.

Some non-profit medical facilities provide medical care free or at a reduced price. Patient advocacy organizations for various chronic conditions may offer financial assistance.

Programs and Resources to Help With Cancer-related Expenses
Heart disease-related expenses
National Breast and Cervical Cancer Early Detection Program (NBCCEDP) – Get free or low-cost breast and cervical cancer screenings. Eligibility for NBCCEDP is based on income, age, and whether you are uninsured or your insurance does not cover screenings.
Ryan White HIV/AIDS Program – Find help in your state or local area with HIV/AIDS medications and treatments. You may qualify for this program based on your income. And you must be uninsured, or the treatments and medications you need are not covered by your current insurance plan.
These Nonprofits Offer Financial Aid to Patients and Families

Get help paying medical bills through debt management

Despite using insurance and extra sources of help you may find yourself forced to deplete savings. You may owe more money than your budget allows you to pay regularly. You are in debt.

You may be able to get help paying your medical bills with a debt management plan. This involves a payment schedule that a credit counselor develops based on your situation.

When you pay, your money is deposited into an account with the credit counseling organization, which then pays your debt. You may be able to get lower interest rates and certain fees waived to help make it easier to pay off your medical debt.

Learn more about debt management and how it works.

The Pexels images in this post are for illustration only and do not depict real medical situations.

Exploring the HEART of Health

I hope you learned something here that helps you or someone else. Please forward it to a friend or share on social media.

In another piece, I will discuss obtaining medicines and vaccines.

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Medical stethoscope and heart on a textured background

Dr Aletha

How U.S. Healthcare Spending Fails Patients

The murder of a high profile healthcare executive highlights issues surrounding the U.S. healthcare system, particularly its high costs and poor outcomes. Frustrated by healthcare inefficiencies, patients and doctors criticize the profit-driven insurance industry, believing significant administrative expenses hinder patient care. It has provoked a hard look at a problem that needs a solution if we want to improve health outcomes and lower costs.

Like you, I have been following the news stories of Brian Thompson and Luigi Mangione. I can’t remember another time when an alleged killer received more understanding and sympathy than the victim. (Although it has probably happened.)

Based on what is known now, the murder was connected to one man’s occupation, healthcare insurance executive, and the other man’s grievance, healthcare cost and delivery. I am sharing this post from Minnesota Reformer, slightly edited to focus on the healthcare issue, not the crime.

This story won’t be going away anytime soon, and shouldn’t. I hope this tragedy prompts a serious review and changes in how we provide and fund healthcare in the United States.

I also believe whoever is proven to be Mr. Thompson’s killer should be brought to justice. And I want Mr Mangione to receive attention to and treatment for his obviously significant medical issues.

(photos for illustration only)

The original title of this article is

A man radicalized by statistics

by Christopher Ingraham, Minnesota Reformer
December 12, 2024

In a note he was carrying when he was arrested, Luigi Mangione paints himself as a man radicalized by statistics.

“The US has the #1 most expensive health care system in the world, yet we rank roughly #42 in life expectancy,” wrote the alleged killer of Brian Thompson, the late CEO of Eden-Prairie-based UnitedHealthcare.

“United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but [h]as our life expectancy?”

Mangione is a scion of a rich, connected Maryland real estate family who recently withdrew from friends and family following severe medical issues. The numbers he cites are, in broad strokes, accurate.

Photo by Karolina Grabowska on Pexels.com

Healthcare by the dollars

On life expectancy, the U.S. ranks somewhere in the 60s among the world’s countries, according to data from the United Nations, falling in between Panama and Estonia. Among the wealthy subset of countries that are part of the Organization for Economic Cooperation and Development, we rate 32nd out of 38.

The U.S. also spends far more on health care than any other country in the world: around $12,000 per person each year, thousands of dollars more than the next-highest spenders.

The discrepancy between the staggering amount of health care spending and our relatively short lives has been perennial fodder for commentary and political debate: Where is all that money going?

The answer, to a significant degree, is that it’s being skimmed off by the private health insurance industry.

“The largest component of higher U.S. medical spending is the cost of health care administration,” according to an analysis by Harvard health economist David Cutler. “About one-third of health care dollars spent in the United States pays for administration.”

Peer countries, even those that have similar systems with multiple private insurers, pay just a fraction as much.

“Whole occupations exist in U.S. medical care that are found nowhere else in the world, from medical-record coding to claim-submission specialists,” Cutler writes.

That excess spending adds up to something like half a trillion dollars each year, according to a recent analysis of Congressional Budget Office data by Matt Bruenig of the People’s Policy Project. For every $100 spent on health care, $16 goes directly to private insurance companies and another $16 goes to hospitals to cover the cost of administering care.

Only about $68 goes toward actually paying for medical services.

Under a single-payer system, on the other hand, the CBO estimates that the public insurer would need just $1.60 of that hundred bucks to cover its costs, while the hospitals would only need $11.80 to cover administration, because they no longer have to deal with the hassle of multiple private health insurers.

Under that system, $86.60 would go toward paying for care.

UnitedHealth Group

As the nation’s top health insurer and the fourth-largest company by revenue, UnitedHealth Group — the parent company of UnitedHealthcare — is also the chief beneficiary of all those billions in essentially wasted spending. In 2023 the company socked away $22 billion in profits on $371 billion in total revenue, adding up to a return for investors of $25 per share.

Think of it this way: A person who owned a single $500 share of UnitedHealth Group stock at the start of the year would get rewarded, at the year’s end, with $25 of America’s health care spending, despite contributing precisely nothing to American health care.

Those profits, it should be noted, don’t simply generate themselves. UnitedHealthcare has developed a reputation for being especially ruthless in its pursuit of shareholder value. The company “relentlessly fought to reduce spending on care, even as its profits rose to record levels,” ProPublica reported last year.

A U.S. Senate committee concluded UnitedHealthcare, along with other insurers, intentionally denied critical nursing care to stroke patients in order to increase profits. The company has been accused of using rigid algorithms to determine when to cut off payments, regardless of whether or not patients still needed care.

Thompson had been accused of dumping stock before the company alerted shareholders that UnitedHealth Group was being targeted by a federal antitrust investigation.

What happens to patients?

Virtually every American has their own horror story to tell of the Kafka-esque indignities of fighting with insurers over billing codes, prior authorizations, pre-approvals, in-network providers, and the like. This likely explains the organic outpouring of condemnation launched at the health insurance industry in the wake of Thompson’s killing, which spanned the political spectrum, even as elites of both parties scolded the vigilante apologists.

Doctors say the delays caused by those barriers between patients and their care, which are set up largely to protect insurance company profits, can make patients sicker and in some cases kill them.

Photo by Andrea Piacquadio on Pexels.com

In his manifesto, Mangione lamented that so little has been done to solve the profit-driven dysfunction of the health insurance system. “Many have illuminated the corruption and greed (e.g.: [Elisabeth] Rosenthal, [Michael] Moore), decades ago and the problems simply remain,” he wrote. “It is not an issue of awareness at this point.”

The note makes no mention of any personal struggles with the insurance system, despite evidence that Mangione suffered from chronic back pain and underwent major surgery for it.

But at some point — whether driven primarily by personal experience, systemic frustration, or the sheer force of a mental breakdown — Mangione decided to take things into his own hands.

republished under Creative Commons license from

Minnesota Reformer -part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com.