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Facts or Myths?

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Test your knowledge about U.S. health care insurance coverage
and find out which statements are facts
and which are myths. Discover why we believe You Deserve Better.

The US has one of top 10...
  1.  The U.S. has one of the top 10 health care systems in the world.  

Myth:  Compared with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom, the United States ranked 11th on access to care, administrative efficiency, equity, and health care outcomes. Learn more: Mirror, Mirror 2021: Reflecting Poorly | Commonwealth Fund

2.  Most people get their health insurance through their employer.

Fact:  About 54% of Americans get health insurance through their employers. Another 35% are on a government-provided plan such as Medicare or Medicaid. An additional 4% with insurance get it through the marketplace set up in the Affordable Care Act. Read more

3.  My health insurance will cover me as soon as I sign up.

Myth:  Employers can impose a 30- to 90-day waiting period before becoming eligible for health insurance. When changing jobs, it's important to check with your employer to find out the waiting period for health insurance benefits.

4.  Universal health care insurance would be too expensive.

Myth:  Over 29 million U.S. residents have no insurance and an additional 26 percent are underinsured—they are unable to access needed care because of prohibitively high costs. Other high-income countries spend an average of about 40 percent less per person and produce better health outcomes. Universal health care could reduce total health care spending in the U.S. by nearly 10 percent, to $2.93 trillion, while creating stable access to good care for all U.S. residents.

5.  Anyone can get care, when they need it. 

Fact & Myth:  Although anyone can access care through the hospital emergency room, those who are uninsured or underinsured often delay care because they are afraid of the cost. Those who don’t qualify for Medicare, but still are unable to pay for insurance with their own money are left with no coverage and no means to pay for their medical bills. Medical bills contribute to two-thirds of U.S. bankruptcies.

6. If you have health insurance, you have access to care when and where you need it.

Fact & Myth:  Some types of health insurance plans such as, Health Maintenance Organizations (HMOs) only cover care by providers in their network. If you receive care outside of the network, you have to pay the full cost. Other barriers include physicians do not accept patients with Medicaid (31%), physicians who do not accept new patients and transportation difficulties, especially in rural areas where some household members may travel over 100 miles to receive their medical care. 

7. If my doctor recommends a procedure, my insurance will cover the cost. 

Myth - Not necessarily. Although your doctor can recommend you have a procedure, diagnostic test or surgery, your insurance plan must still approve it. If denied, you are responsible for the full cost. 

8. In the U.S. you can always get care if you need it.

Partial Fact- While it is true that hospital emergency rooms are required to see all patients, costs can keep people away, which increases the risk of serious illness and death. Two-thirds of U.S. family bankruptcies are related to health care costs, and up to one-third of COVID-19 deaths have been linked to insurance gaps. 

9. If everyone in the U.S. has health care coverage, I'll have to wait longer to see a physician.

Myth:  If you are a new patient, you may already have to wait months to see a physician. In the U.S., even people with a doctor's referral may still have to wait four to six months to get an appointment, especially with a specialist. However, if you have an emergency and need an MRI, the hospital will prioritize your need and perform the MRI as quickly as possible.

10. The Affordable Care Act rquires coverage for preventive care, such as well-woman exams, screening
mammorgrams, and screening colonoscopies without copays or deductibles.

Fact: However, in September 2022, Texas federal court Judge Reed O’Connor ruled that this portion of the ACA was

unconstitutional. (He is the same judge that ruled the entire ACA unconstitutional in 2018, a ruling that was

subsequently overturned by the US Supreme Court). While this ruling is not yet in effect, pending additional

arguments, and if implemented will likely be appealed, it has the potential to deprive hundreds of millions of Americans

of necessary care, resulting in delayed detection of disease and worsened outcomes. For more information, see The

Commonwealth Fund’s blog and Wall Street Journal’s article on the matter.

11. Rich people don't have any trouble getting the health care that they need.

Myth: Contrary to public belief, even affluent families have trouble affording health care. The Asclepius Initiative’s 2022 Survey of 1000 adult Kentuckians found that overall, 65% of those surveyed avoided, skipped, or stopped medical care or medications secondary to cost. When broken down by annual household income, nearly half of households with annual incomes of between $100,000-$150,000, 40% with incomes of $150,000-$200,000, and over a quarter (27%) with incomes over $200,000 avoided, skipped, or stopped medical care or medications secondary to cost.

 

 

 

 

The Kentucky statistics are even more alarming than a 2021 report based on a West Health-Gallup poll of 6600 US adults, showing that nearly 1/3 of Americans did not seek treatment for care in the previous 3 months secondary to cost, including 20% of those with annual household incomes over $120,000.

The upshot is that a system that requires out-of-pocket costs beyond what they can afford to pay is an impediment to the well-being of almost all Americans.

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