So why doesn’t everyone have insurance?
In the US, the best, most affordable insurance plans are usually obtained as perks of employment. Employers often get ‘bulk discounts’ from insurance companies and cover part of their employees’ premiums. Being unemployed, a freelancer, or employed somewhere that doesn’t offer health insurance is often the first major hurdle to obtaining health insurance.
When insurance through an employer (or a spouse or family member’s employer) is not an option, people can go to one of a few government options. These options tend to be bureaucratically complex, especially for those with complicated immigration or citizenship status.
- ACA Exchange programs: These state-run programs work much like employer-sponsored insurance. Different plans are available at different price-points, with some subsidized by the government for those that qualify. They are open to all at healthcare.gov, but only people who meet certain qualifications are able to enroll outside of the usual annual enrollment period.
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Medicare: This is a government-run insurance program for those of retirement age that Americans pay into as part of our payroll taxes during our working years. Learn more at Medicare.gov.
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Medicaid: This government-run insurance system is for those who cannot afford other forms of health insurance. Eligibility varies from state-to-state. Check Medicaid.gov to learn about Medicaid in your state.
- Medicaid is there for those who can’t afford anything else, but as explains, it’s rife with problems in some states. [Optional]
Subsidies play a complex role in this dynamic too. Let’s get a little more nuance from Peter: