There is no denying the fact that health insurance plans are the need of the hour. Many factors have led to the decline in health of the masses, and this has put a huge burden on the healthcare infrastructure. Only good health insurance plans, which are designed keeping in mind the ground realities of the citizens and their healthcare needs, can provide relief to the system and the common man. As such, health insurance plans have expanded in scope in the last decade to keep up with the needs of the times. Here are some of the ways in which health insurance plans have evolved in the last 10 years.

One of the most significant ways health insurance plans have changed in the past decade has been due to the Affordable Care Act (ACA). The act has ensured that those who come from low- and middle-income families don't get left behind in terms of health insurance coverage. It has also brought in many essential benefits and increased subsidies, which have helped reshape the healthcare landscape of the country. It has also improved coverage for young adults by allowing them to be a part of their parents' plans till they are 26 years of age.

Lower-income groups have been the most neglected when it comes to accessibility to good healthcare. But the irony is that they are the ones who need it the most. Over 40 states have greenlit Medicaid expansion under ACA, which has led to the increase in coverage for those who belong to the lower income groups. This is a positive development, as increased coverage leads to better outcomes and puts less stress on the healthcare ecosystem as a whole. This expansion has benefited over 20 million people who now have access to healthcare.

Everyone should get access to good healthcare, but that is not the case. The US doesn’t have universal healthcare to address the needs of all of its citizens, including those coming from the poorer sections of society. But changes have been made over the last decade that have alleviated some of the healthcare concerns of the consumers. One such change is relief for those with pre-existing conditions, as they can’t be denied health insurance based on that fact alone any longer. ACA has also mandated that plans that are ACA-compliant cover 10 essential health services, including maternity, mental health, and hospitalization. Annual and lifetime limits on treatments that are long-term and expensive have also been eradicated. Plans will also have to be renewed regardless of change in health status of the customer.

The ACA marketplaces were introduced in 2014. Since then, over 49 million Americans have signed up for ACA marketplaces. In 2024 alone, over 20 million people signed up for the same. The increase was noted in states that had not opted for Medicaid program expansion or opted for it later.

There has been an increased preference for marketplace and public health insurance options. One of the biggest reasons for this rise is the decrease in employer-sponsored health insurance plans for those who have retired. Other factors that have driven this preference include income inequality, unhappiness with private health insurance monopolies, and technological innovations.

In the traditional healthcare model, healthcare providers were paid based on the number/volume of services they provided. This was irrespective of the health outcome of the patient. This model is slowly being replaced by the value-based care system, which puts more emphasis on quality of treatment rather than quantity. It also leans more towards better health outcomes for the patients through alternative payment models such as bundled payments, accountable care organizations, and pay-for-performance. Some of the benefits of this system include better outcomes for patients, lower cost of care, improved healthcare experience for the patient, and more focus on prevention and care for chronic conditions.

There is still a long way to go when it comes to health insurance plans and their scope to address the lapses in coverage. While the ACA has improved an average American’s access to health care and reduced their financial burden, the cost of medical care and premiums is on the rise. And there are still many who are unable to get healthcare at the right time and for the right price. Their needs have to be met, and this can only happen if a holistic approach to healthcare is taken.