History of Health Insurance
This war was responsible for ending first attempts at developing a state-sponsored health insurance program
What is World War I?
This was primarily due to anti-german sentiment in the country and opposition from the American Federation of Labor (wanted to maintain union strength). A similar pattern was repeated when Truman called for national health insurance after WWII
This federal law allows employees to keep their employer-sponsored health insurance temporarily after losing their job, though they must pay the full premium themselves.
What is COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA allows employees to continue their employer-sponsored health insurance for up to 18–36 months after leaving their job (due to quitting, being laid off, or reduced hours)
This group of individuals primarily qualifies for Medicare coverage in the United States?
Who are people 65 and older, and certain younger individuals with disabilities or end-stage renal disease (ESRD)?
These two sectors account for most of US health-insurance spending.
What are Hospital care and professional/provider services?
Health coverage provided by non-governmental insurers, either through employer-sponsored plans or individually purchased policies is known as ______.
What is private health insurance? ⅔ of americans are covered through private plans.
1929 and 1943 are the founding dates for the birth of the two original major US insurance systems (a pre-paid hospital plan and a pre-paid physician services plan, respectively)
What are Blue Cross and Blue Shield?
In these plans, individuals pre-paid for the respective service and care was guaranteed by the organization. In 1982, the two systems merged into what we know as BCBS
This insurance program provides low-cost coverage for children whose family income is too high for Medicaid but too low to afford private insurance
What is CHIP (Children’s Health Insurance Program)?
A single parent earning 180% of the federal poverty level might not qualify for Medicaid but can enroll their children in CHIP, ensuring access to pediatric visits, immunizations, and dental care
Medicare consists of four parts: this is the purpose of parts C and D.
What is Part C: Medicare Advantage (private plans bundling A & B, often D). Part D: Prescription drug coverage
This is the reason administrative costs which are a major driver of U.S. healthcare spending compared with other nations.
What is the multi-payer system?
(many insurers and plans) requiring extensive billing, prior-authorization, and coding processes.
These are the two main types of private health insurance markets in the US.
What are the group market (employer-sponsored insurance) and the Individual market (plans people buy themselves, including through the ACA marketplace)?
This federally-sponsored health insurance program was funded by the government in 1965, originally consisting of a Part A for hospital insurance and Part B for outpatient services
Medicare now consists of four parts (C and D).
This type of insurance provides wage replacement and medical benefits to employees injured on the job, protecting both workers and employers.
What is worker's compensation?
A state-mandated insurance program that provides wage replacement and medical care to employees injured while performing their job duties, regardless of fault.
What are Payroll taxes (Part A), general federal revenues and premiums (Part B & D).
The US medical system has ____ prices compared to other countries and individuals receive ____ care
What is higher prices and no more care?
These are the 4 cost-sharing features common to most private insurance plans.
What are Premiums, deductibles, co-pays, and co-insurance.
These two insurance systems to control rising costs of care are called accountable care organizations and were developed beginning in the 1970s and 1980s respectively
What are HMOs (health maintenance organizations) and PPOs (Preferred provider organizations)?
HMOs provide a provider network that enrollees must stay within while PPOs grant more patient choice when selecting a provider though also incentivize staying in network
In Medicare Part D prescription drug coverage, this term describes the gap when patients must pay a higher share of drug costs after an initial coverage limit is reached.
What is the Donut Hole?
Beneficiaries must pay a higher portion of medication costs after reaching a spending threshold, until they hit the “catastrophic coverage” level.
This is a term used to describe someone who is eligible for both medicare and medicaid.
What is dual eligibility?
Medicaid helps pay for premiums, copays, and long-term care not covered by Medicare
This type of insurance system rewards utilization over value, paying doctors and hospitals for each procedure and visit.
What is fee-for-service insurance?
These are two major challenges facing private health insurance today.
What are rising premiums and out-of-pocket costs outpacing wages and fragmentation and administrative complexity due to multiple insurers and networks.
This health insurance bill was enacted in 2010 and implemented an individual mandate to purchase health insurance, ensured rates would not be set on existing conditions and provided government subsidies for coverage.
What is the American Care Act/Obamacare.
After meeting the deductible, this is the percentage of healthcare costs the patient pays, while insurance covers the rest.
What is co-insurance?
A cost-sharing mechanism where, after meeting the deductible, the patient pays a fixed percentage of medical costs, and insurance covers the rest. (e.g., 80/20 plan → insurer pays 80%, patient pays 20%.)
Medicare does not cover certain categories of expenses. These are:
What are dentistry, vision exams/glasses, hearing aids and long term care.
These are three broader forces shaping healthcare today.
What are the aging demographics, rapid technological innovation and efforts to increase equity.
In 2023, this was the average annual premium for employer-sponsored family coverage in the U.S. and employees typically contributed the following amount.
What is $24,000 total per year and around $6,500 (roughly one-fourth)?