Health insurance in the United States

Question

This piglix contains articles or sub-piglix about Health insurance in the United States

Answer 1

Medicare and Medicaid (United States)

This piglix contains articles or sub-piglix about Medicare and Medicaid (United States)

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Answer 2

Health insurance marketplaces

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Answer 3

Members of Blue Cross Blue Shield Association

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Answer 4

Health insurance in the United States

In the United States, health insurance is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a social welfare program funded by the government. Synonyms for this usage include "health coverage," "health care coverage" and "health benefits."

In a more technical sense, the term is used to describe any form of insurance that provides protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs such as Medicaid and the State Children's Health Insurance Program, which provide assistance to people who cannot afford health coverage.

In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40 percent of insured individuals reporting that their plans do not adequately meet their needs as of 2007.

The share of Americans with health insurance has been steadily declining since at least 2000. As of 2010 just under 84% of Americans had some form of health insurance, which meant that more than 49 million people went without coverage for at least part of the year. Declining rates of coverage and underinsurance are largely attributable to rising insurance costs and high unemployment. As the pool of people with private health insurance has shrunk, Americans are increasingly reliant on public insurance. Public programs now cover 31% of the population and are responsible for 44% of health care spending. Public insurance programs tend to cover more vulnerable people with greater health care needs. Many of the reforms instituted by the Affordable Care Act of 2010 were designed to extend health care coverage to those without it.

According to the United States Census Bureau, roughly 55% obtain insurance through an employer, while about 10% purchase it directly. About 31% of Americans were enrolled in a public health insurance program: 14.5% (45 million – although that number has since risen to 48 million) had Medicare, 15.9% (49 million) had Medicaid, and 4.2% (13 million) had military health insurance (there is some overlap, causing percentages to add up to more than 100%). Employers may also provide reimbursement for health insurance purchased individually by their employees through a Defined contribution health benefits plan. Employers are allowed to pay employees cash in lieu of health insurance, but this is uncommon as it is subject to strict IRS regulations.

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Answer 5

Health insurance coverage in the United States

The number of people without health insurance coverage in the United States is one of the primary concerns raised by advocates of health care reform. A person without health insurance is commonly termed uninsured (regardless of insurance of objects unrelated to health), and this article uses the term in this sense as well.

Multiple surveys indicate the number of uninsured has fallen due to expanded Medicaid eligibility and health insurance exchanges established due to the Patient Protection and Affordable Care Act, also known as PPACA or "Obamacare". These changes took effect March 23, 2012. The Commonwealth Fund reported in July 2014 that an additional 9.5 million people aged 19–64 had obtained health insurance, roughly 5% of the working-aged population.Gallup reported in July 2014 that the uninsured rate among adults 18 and over fell from 18.0% in Q3 2013 to 13.4% by Q2 2014.Rand Corporation had similar findings.

According to the United States Census Bureau, in 2012 there were 48.0 million people in the US (15.4% of the population) who were without health insurance.

The causes of this rate of uninsurance remain a matter of political debate. Rising insurance costs have contributed to a trend in which fewer employers are offering health insurance, and many employers are managing costs by requiring higher employee contributions. Many of the uninsured are the working poor or are unemployed. Others are healthy and choose to go without it. Some have been rejected by insurance companies and are considered "uninsurable". Some are without health insurance only temporarily. Some choose faith-based alternatives to health insurance.

Gallup estimated in July 2014 that the uninsured rate for adults (persons 18 years of age and over) was 13.4% as of Q2 2014, down from 18.0% in Q3 2013 when the health insurance exchanges created under the Patient Protection and Affordable Care Act (PPACA or "Obamacare") first opened. The uninsured rate fell across nearly all demographic groups.

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Answer 6

Individually purchased health insurance

In the United States, individually purchased health insurance is health insurance purchased directly by individuals, and not those provided through employers. Self-employed individuals receive a tax deduction for their health insurance and can buy health insurance with additional tax benefits. According to the US Census Bureau, about 9% of Americans are covered under individual health insurance. In the individual market, consumers pay the entire premium without an employer contribution, and most do not receive any tax benefit. The range of products available is similar to those provided through employers. However, average out-of-pocket spending is higher in the individual market, with higher deductibles, co-payments and other cost-sharing provisions. Major medical is the most commonly purchased form of individual health insurance.

Premiums can vary significantly by age. In states that allow medical underwriting, an individual's health information may be used in determining whether to cover the individual and the premium to be paid. However, under the Patient Protection and Affordable Care Act, effective since 2014, insurers are prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions. For individuals who pass individual medical underwriting where it is used, the average premiums they pay are lower than the average paid for employer-sponsored coverage (this comparison is based on the entire premium for employer-sponsored coverage, including both the employee and employer contributions). Factors that may contribute to this include: differences in age; less generous coverage in the individual market (higher beneficiary cost sharing); and a tendency for individual consumers to only buy benefits that they expect to need and use while group coverage may provide some benefits that most beneficiaries do not use. Individual policyholders are also more likely to report being in excellent health than are people covered by employer-sponsored health insurance, which may be a contributing factor. Premiums in the individual market rose less rapidly over the period 2002-2005 than did out-of-pocket premiums in the employer-sponsored market (17.8% versus 34.4%). The increase was larger for family policies than for single policies (25.3% for family policies; the increase for single policies was not statistically significant). These comparisons did not adjust for changes in benefit levels.

Research confirms that the individual health insurance market is sensitive to price. Estimates of demand elasticity in this market vary, but generally fall in the range of -0.3 to -0.1. It appears that price sensitivity varies among population subgroups and is generally higher for younger individuals and lower income individuals. One study found that among individuals who lack other sources of health coverage, the percentage purchasing individual insurance increases steadily with income. However, even among those with incomes four times the federal poverty level, only about a fourth buy individual coverage. The self-employed, who can tax-deduct their premiums, are more likely to purchase than other individuals. The researchers concluded that affordability appears to be a key barrier to coverage in this market, and that any premium subsidies would likely have to be substantial to be effective. The researchers note that other factors such as health status and the complexity of the market can also affect the purchase of individual health insurance, but conclude that they are unlikely to be the primary drivers of low coverage rates.

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Answer 7

Anthem Inc.

Anthem Inc.

Anthem Inc. is an American health insurance company founded in the 1940s, prior to 2014 known as WellPoint, Inc. It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. It was formed when Anthem Insurance Company acquired WellPoint Health Networks, Inc., with the combined company adopting the name WellPoint, Inc.; trading on the NYSE for the combined company began under the WLP symbol on December 1, 2004. On December 3, 2014, WellPoint changed its corporate name to Anthem Inc, and its NYSE ticker changed from WLP to ANTM.

Anthem Insurance Company grew out of two Indianapolis, Indiana based mutual insurance companies, Mutual Hospital Insurance Inc. and Mutual Medical Insurance Inc. formed in 1944 and 1946. The companies grew significantly, controlling 80% of the medical insurance market in Indiana by the 1970s. In 1972 they came together to create a joint operating agreement, and merged in 1985 as parent company, Associated Insurance Companies, Inc, to form Blue Cross and Blue Shield of Indiana.

In 1986 Associated Insurance Companies changed its name to The Associated Group (TAG) to reflect its expanded focus, and began heavily expanding outside Indiana, acquiring numerous insurance companies and creating new subsidiaries throughout the late 1980s through the mid-1990s.

Formerly Anthem Inc. was an insurance company which began in the 1980s as a spin-off of the group insurance operations of American General Insurance.

Anthem Blue Cross and Blue Shield was created as part of the merger of The Associated Group with Community Mutual Insurance Co. of Cincinnati.

From its move to a publicly traded company in 2001 until its final merger in 2004, it merged the Blue Cross Blue Shield organizations of several states to achieve economy of scale, converting them in the process from non-profit to for-profit status. In late 2004, Anthem and WellPoint merged, with the combined company taking the WellPoint name. That Anthem no longer exists as a company, but the Anthem Blue Cross and Blue Shield brand name is used by WellPoint in 11 states.

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Answer 8

Anthem medical data breach

The Anthem medical data breach was a medical data breach of information held by Anthem Inc.

On February 4, 2015, Anthem, Inc. disclosed that criminal hackers had broken into its servers and potentially stolen over 37.5 million records that contain personally identifiable information from its servers. On February 24, 2015 Anthem raised the number to 78.8 million people whose personal information was affected. According to Anthem, Inc., the data breach extended into multiple brands Anthem, Inc. uses to market its healthcare plans, including, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross and Blue Shield, Amerigroup, Caremore, and UniCare.Healthlink says it was also a victim. Anthem says the medical information and financial data was not compromised. Anthem has offered free credit monitoring in the wake of the breach. According to Bloomberg News, China may be responsible for this data breach. Michael Daniel, chief adviser on cybersecurity for President Barack Obama, said he would be changing his own password. According to The New York Times about 80 million company records were hacked, and there is fear that the stolen data will be used for identity theft. The compromised information contained names, birthdays, medical IDs, social security numbers, street addresses, e-mail addresses and employment information, including income data.

The data was stolen over a period of weeks the month before the data breach was discovered.

Anthem was not required by law to encrypt the data. However, Anthem faced several civil class-action lawsuits, which were settled in 2017 at a cost of $115 million. Anthem did not admit any wrongdoing in the settlement.

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Answer 9

Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts (BCBSMA) is a state licensed private health insurance company under the Blue Cross Blue Shield Association with headquarters in Boston.

BCBSMA formed in 1988 after the merger of Blue Cross and Blue Shield of Massachusetts. In 1992 it offered an HMO plan along with the rise of managed care in the 1990s.

BCBSMA has non-profit status as a health insurer and has 2.8 million policyholders, the largest number of any insurer in Massachusetts, with most policyholders insured through employers. The number of policyholders dropped slightly between the first and second quarters of 2011, due to the economy and layoffs.

The organization's compensation for its departing CEO, Cleve Killingsworth, totaled $8.6 million in 2010. When this was reported in 2011, public anger and a four-month investigation from the Massachusetts Attorney General followed. BCBSMA ultimately credited $4.2 million, representing Killingsworth's severance, off policyholders' premiums (~$3 per policyholder).

The company has received praise for its innovative alternative quality contract (AQC) payment model. In 2007, then-CEO Cleve Killingsworth set a six-month deadline for the company to come up with a new payment plan to offer health care providers. Killingsworth thought existing pay for performance initiatives were insufficient to prevent billions of dollars in wasteful health care spending that either harmed or did not help patients. AQCs were established in January 2009 and they serve as a model for global payments—in contrast to the fee-for-service model, which encourages excessive treatments—in the state. AQCs were envisioned as a way to increase provider accountability. They are based on the capitation approach that was tried in the 1990s, but with a bonus for patient quality outcomes to serve as a disincentive against providers neglecting patients. The word "capitation" was discouraged during company meetings, as it proved unpopular with providers under the managed care of the 1990s. Under the AQC model, groups of doctors and hospitals are paid set fees "to work as a team in caring for patients." In the first year of implementation, AQCs resulted in medical cost savings in all participating provider groups, but the incentives that BCBSMA paid to providers are estimated to have made up for the savings. As of October 2011, approximately 613,000 people were covered by BCBSMA under the AQC model (roughly two-thirds of BCBSMA members in health maintenance organizations), but the model had not been applied to policyholders in preferred provider organizations.

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Answer 10

Blue Shield of California

Blue Shield of California

Blue Shield of California is a health plan provider founded in 1939 and based in San Francisco, California. The organization serves over 4 million health plan members and nearly 65,000 physicians across the state. Blue Shield of California was founded by the California Medical Association. Founded as a not-for-profit, Blue Shield of California was stripped of its tax-exempt status by the California Franchise Tax Board in 2014.

Blue Shield of California, then known as California Physicians' Service, was created by the California Medical Association on December 18, 1938, and was incorporated on February 2, 1939. The organization began offering coverage on March 6 of that same year. In 1946, the organization was among a founder of the National Association of Blue Shield Plans, which later became the Blue Cross and Blue Shield Association. Today, Blue Shield of California is an independent licensee of the national association. The Blue Shield of California health plan was the first in the nation to offer catastrophic coverage in 1950, provide coverage for a heart transplant in 1984, offer online benefit and enrollment information in 1996, and offer an online enrollment system for agents in 1998. In 2006, the National Committee for Quality Assurance, commonly referred to as NCQA, recently recognized Blue Shield as an "excellent" health plan for service and clinical quality.

In 2010, Blue Shield of California, Dignity Health, and Hill Physicians Medical Group formed an Accountable Care Organization that covers 41,000 individuals in the California Public Employees Retirement System (CalPERS). During its first 2 years, this program reduced inpatient use and health care costs significantly.

In 2014, Blue Shield of California lost its exemption from California state corporate income tax but did not officially announce this information to the public until March 2015. A claimed recent application of the Duck test was the denial of tax exempt "nonprofit" status to Blue Shield of California.

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