The Importance of Health Insurance in the U.S.

Having meaningful health care coverage is important for leading a secure and healthy life. In the U.S., people get health coverage from both private and public sources. Private options include getting coverage through an employer or buying it directly from the individual market. Public options include programs like Medicare, Medicaid, and Veterans Affairs. 

In recent years, more people have gained health insurance, with nearly 20 million newly insured. Many of these individuals enrolled in coverage through Medicaid, their employer, or the individual market. This increase is largely due to the Affordable Care Act (ACA). It introduced coverage programs and reformed insurance markets. These changes have made health insurance more accessible to many across the country.

This article will explore the importance of healthcare coverage, examine recent statistics, and highlight the benefits it offers.

2024 Statistics

In 2023, 89.1% of adults aged 18 to 64 had health insurance at some point. However, 7.6% of Americans of all ages remained without coverage. Around 41% of adults reported having debt from unpaid medical or dental bills, highlighting the ongoing financial burden of healthcare. Texas had the highest rate of uninsured nonelderly adults at 18.9%, while Massachusetts had the lowest at 2.8%.

Hispanic and Black working-age adults were less likely to have health coverage compared to white, non-Hispanic, or Asian adults in 2023. Financial strain led many adults to delay necessary care, with dental services being the most commonly postponed, followed by vision services and doctor visits.

By 2024, unexpected medical bills and healthcare costs remained top concerns for Americans. The cost of care prevented 9.3% of adults from seeing a doctor in 2022. On average, healthcare expenditures per person in the U.S. were $12,555 in 2022, significantly higher than in other high-income countries. Total national healthcare spending reached $4.5 trillion in 2022, a slight increase from 2021.

Preferred provider organizations (PPOs) continued to be the most common type of health plan, followed by high-deductible health plans (HDHPs). A slight increase in insured adults aged 18 to 64 was noted in 2023 compared to 2022. Meanwhile, the number of uninsured children aged 0 to 17 slightly decreased, and the uninsured rate among elderly adults increased marginally.

In 2023, 7.6% of all Americans were uninsured, a decrease from 10.3% in 2019. The main reason nonelderly adults cited for not having insurance was the high cost, followed by eligibility issues and a lack of perceived need. The South had the highest percentage of uninsured working-age adults, followed by the West. Among those without coverage, Hispanic adults had the highest uninsured rate at 24.8%. This was followed by Black adults at 10.4%, Asian adults at 4.4%, and non-Hispanic white adults at 6.8%.

Benefits

Health insurance significantly boosts access to medical care. For example, adults with Medicaid are five times more likely to have regular care sources and four times more likely to receive preventive services compared to those without coverage. Children with Medicaid are similarly advantaged, having regular care and preventive services much more often than uninsured children. Additionally, low-income children with Medicaid-covered parents are more likely to receive well-child visits.

People in states that expanded Medicaid generally have a personal doctor more often than those in states that did not. Coverage also improves access to necessary prescription medications. For instance, those in expansion states have better access to diabetes and asthma drugs, contraceptives, and heart medications.

Tarek el Ali, Founder of Smart Insurance Agents said, “Insurance helps with early diagnosis and treatment, leading to better health outcomes. In expansion states, diabetes diagnoses are more common, and care for common surgeries and cancer is more timely. Medicaid expansion also enhances access to mental health and substance abuse treatments. Young adults with coverage visit mental health services more frequently. In states like Ohio and Connecticut, those who gained Medicaid access reported better mental health services and utilization.”

Medicaid expansion has been crucial in battling the opioid crisis. In West Virginia, those with Medicaid were more likely to receive medication for opioid use disorder. Coverage reduces cost barriers to care, making individuals less likely to skip medications due to financial concerns. In rural areas, cost barriers are also lower in expansion states.

Coverage expansion is linked to better health outcomes. For example, after Massachusetts expanded coverage, overall mortality rates dropped. Expansion also correlates with lower rates of cardiovascular deaths and higher rates of smoking cessation. In Oregon, those who gained Medicaid coverage experienced lower depression rates. 

Insurance helps guide people to appropriate care. Young adults on their parents’ health plans are less likely to visit emergency rooms for non-emergencies. Expansion states have seen fewer emergency visits and more outpatient care. Preventive care and chronic condition management also improve with coverage.

Coverage benefits individuals, families, and communities. Hospitals in expansion states, especially rural ones, have better financial stability and are less likely to close. Medicaid expansion is linked to a decrease in violent and property crimes. It also reduces financial burdens, leading to fewer medical bills and catastrophic expenses. In states like Ohio and Montana, Medicaid expansion has created jobs and increased personal income. In Michigan, it has improved financial health, particularly for those with chronic illnesses.

Costs and Challenges

Healthcare costs in the U.S. present significant challenges. Utah has the lowest healthcare expenses per capita, averaging $7,522, while Washington, D.C. has the highest, with an average of $14,381 per person. Hospital costs are also a concern. On average, a hospital stay costs $3,025 per day. In Mississippi, the daily cost is lower at $1,425, while in California, it’s higher at $4,337.

Many U.S. adults struggle with medical debt. About 41% report having debt from medical or dental bills. Nearly 25% of adults, or someone in their household, skipped medication doses, cut pills in half, or didn’t fill prescriptions because of the cost. Hispanic adults were most affected, with 18.7% not seeing a doctor in 2022 due to expenses. American Indian and Alaska Native adults also faced similar challenges, with 13.8% not seeking medical care because of costs. Low-income families, as well as Black and Hispanic families, are particularly burdened by these financial challenges.

In a 2022 survey, 26% of respondents felt that a medical bill under $500 was unaffordable if they had to pay out of pocket. Around 40% of respondents used a credit card to cover medical bills over $500.

The cost of health insurance also adds to the financial burden. The average annual premium for employer-based health insurance is $7,590 for single coverage. Employees contribute $1,637, while employers pay $5,953. Deductibles are another expense, averaging $3,811 per year for family coverage and $1,992 for single coverage. For those buying insurance through the ACA marketplace, a 30-year-old adult pays an average of $512 per month for a PPO plan. A 60-year-old pays more, around $1,224 per month. 

These costs and challenges highlight the financial strain many Americans face when trying to access healthcare.

How Nurses Influence Health Care Insurance in the USA

Chris McDermott, a Certified Advanced Practice Registered Nurse said, “Nurses are vital to the health care insurance system in the USA. They play a key role in managing and coordinating patient care. Their work ensures that patients receive the benefits covered by their insurance plans. By helping patients understand their coverage, nurses make it easier to handle the health system and access needed care.”

Education is a major part of their job. Nurses explain insurance benefits to patients, helping them understand what is covered and how to use their benefits effectively. This knowledge helps patients make informed choices about their health care.

Nurses also handle insurance verification. They check patients’ coverage and eligibility before any treatments or services. This step is important to avoid delays and issues in care.

In case management roles, nurses assess patient needs and work with insurance providers to arrange the necessary services and resources. They advocate for patients to ensure they receive the coverage they need. Nurses also help with filing claims and resolving any insurance problems, making sure all care is documented and covered.

They contribute to improving care quality by examining patient outcomes and insurance data. Their insights help enhance both care delivery and insurance processes. For patients with chronic conditions, nurses create care plans that match their insurance coverage, supporting effective health management within benefit limits.

Types of Health Insurance Plans

When exploring health insurance options, it’s important to understand the different types of plans available. Each type has its own features and costs, and choosing the right one depends on individual needs and preferences.

Preferred Provider Organization (PPO) plans are widely used in group insurance provided by employers. About 47% of workers are covered by PPOs. These plans offer flexibility, allowing access to out-of-network providers and specialists without needing a referral. However, PPO plans generally come with higher premiums.

High Deductible Health Plans (HDHPs) are the second most common, with 29% of workers enrolled in them. HDHPs have lower monthly premiums but higher deductibles. For 2023, the deductible is at least $1,500 for an individual and $3,000 for a family. Out-of-pocket costs for in-network services cannot exceed $7,500 for an individual or $15,000 for a family. Although premiums are lower, out-of-pocket costs can be high if frequent medical care is needed. HDHPs can be paired with Health Savings Accounts (HSAs), allowing tax-free payments for medical expenses.

Health Maintenance Organizations (HMOs) cover 13% of workers. HMOs require policyholders to use only network providers, except for emergencies. They usually need referrals to see specialists. HMOs have lower premiums but less flexibility compared to PPOs.

Exclusive Provider Organizations (EPOs) cover 10% of workers. EPOs also limit coverage to network providers, similar to HMOs. However, EPOs typically do not require referrals to see specialists. Premiums are lower than PPOs but higher than HMOs.

Point-of-Service (POS) plans, covering 1% of workers, combine features of PPOs and HMOs. They require referrals for out-of-network care, which can be more expensive. For in-network care, costs are lower, and referrals are needed to see specialists.

Health insurance is important for managing healthcare costs and getting the care you need. Understanding the different types of plans helps make better choices and ensures coverage fits personal needs and budget.

For more help in choosing the right health insurance, consider talking to a specialist or exploring online resources. Making the right choice can lead to better healthcare and financial peace of mind.