Health Insurance


Since health care is one of the most costly services in the U.S., it is important to have good health insurance plan as part of the benefits package provided by your employer. Full-time government employees receive health insurance plans as part of their benefit packages and may private companies offer health plans as well. Health Maintenance Organizations or (HMO’s) offer prepaid health plans to members who pay a monthly premium. In exchange, the HMO provides comprehensive care for the member’s family, which includes doctors’ visits, hospital stays, emergency care, surgery, laboratory or lab tests, x-rays, and therapy. Some HMO’s will allow members to choose their own doctors, while other HMO’s only cover visits to doctors in that HMO’s network. Members may have to pay a portion of the cost of doctor’s visits in a form of co-pay, which can vary depending on the member’s particular health insurance coverage. If your HMO utilizes a network and you want to see a doctor outside the network, you might have to pay the doctor’s entire fee out of pocket.

For Americans over 65 the government provides a form of health insurance coverage known as Medicare, as part of social security benefits. During your working life you pay taxes to the federal government, and a percentage of the taxes collected from your paycheck goes into the Medicare fund. If you reach 65 but you have not worked consistently, you can still join Medicare, but you have to pay higher deductibles and co-payments. Medicare is divided into three parts: part A covers hospital bills; Part B covers doctor’s bills and Part C provides the option to select a package of health care plans.

There is another federal and state government funded health program called Medicaid, which is exclusively for low-income U.S. citizens, and it is offered in all 50 states. To be eligible, your individual income must not be above the Federal Poverty Level or FPL. Childless couples and single childless adults who are not disabled or elderly are not eligible for Medicaid. Even though Medicaid benefits vary considerably from state to state, the eligible participant can get hospital care, physician services, prescription drugs, mental care, and care for the elderly, among other services provided by Medicaid. Due to the fact that Medicaid is expensive for the Federal Government, it becomes a topic of heated debates amongst politicians running for office.

Vocabulary and Expressions

Costly = costing much, high in price, expensive.
Health insurance = insurance providing compensation for medical expenses.
Benefits package = all the benefits offered by an employer to his or her employee.
Prepaid = paid in advance.
Premium = payment for insurance.
Emergency care = urgent medical care services.
Therapy = treatment of illness or disability.
Co-pay = amount of money that the insured person pays out-of-pocket for medical services.
Retirement = removal or withdrawal from service, office or business.
Collect = to receive or compel payment of.
Consistently = adv, consistent + ly, in a constant way, uninterrupted.
Deductibles = amount of money that can be deducted from your income taxes.
Exclusively = here, limited to the person or people designated.
Low-income = related to individual or households supported by an income that is below average.
Citizens = A person owing loyalty to and entitled by birth or naturalization to the protection of a state or nation.
Income = the monetary payment received for goods, services or from other services such as rent or investments.
Childless couples = couples who do not have any children.
Disabled = unable, incapacitated.
Elderly = advance age, aged members of society.
Considerably = adv, considerable + ly, substantially, amply.
Prescription drugs = brand name drugs prescribed by doctors.
Debates = discussion involving different viewpoints.

Conversation Activities

1. Do you have health insurance?
2. Do you need to make an appointment to see a doctor, or can you just drop by?
3. Who pays for health insurance in your country?
4. Do you need to pay a co-pay after you receive medical services?
5. What are other alternatives to medical care?