how health insurance works
in the united states health insurance is tricky to navigate it is a business with a number of regional and national competitors whose coverage pricing and availability vary from state to state and even by county about half of the u s population has health insurance coverage as an employment benefit with premiums partially covered by the employer the cost to the employer is tax deductible to the payer and the benefits to the employee are tax free with certain exceptions for s corporation employees self employed people freelancers and gig workers can buy insurance directly on their own the affordable care act of 2010 commonly called obamacare mandated the creation of a national database healthcare gov which allows individuals to search for standard plans from private insurers that are available where they live the costs of the coverage are subsidized for taxpayers whose incomes are between 100 and 400 of the federal poverty threshold some states created their own versions of healthcare gov that are tailored to their residents people over the age of 65 and those with disabilities end stage renal disease or als qualify to receive federally subsidized care through medicare while families whose incomes are near the poverty level are eligible for subsidized medicaid coverage types of health insurancehealth insurance can be tricky to navigate in the u s managed care insurance plans require policyholders to get their care from a network of designated healthcare providers if patients seek care outside the network they must pay a higher percentage of the cost the insurer may even refuse payment outright for services obtained out of network many managed care plans for example health maintenance organizations hmos and point of service plans pos require patients to choose a primary care physician who oversees the patient s care makes recommendations about treatment and provides referrals for medical specialists preferred provider organizations ppos by contrast don t require referrals but do set lower rates for using in network practitioners and services insurance companies may deny coverage for certain services that were obtained without preauthorization they may refuse payment for name brand drugs if a generic version or comparable medication is available at a lower cost check an insurance company s rules before your buy their insurance 