Private vs Public Health Insurance
Without insurance, healthcare in the United States is often incredibly costly. To ensure you’re able to get treatment when you need it without emptying your savings, it’s important to find a comprehensive health insurance policy that offers great coverage at an affordable monthly rate.
Health insurance is typically divided into two categories: private health insurance and public health insurance. Public policies are subsidized with government funds while private policies are paid for partially or entirely by the covered individual. But which of these options is right for you? Here’s a closer look at the differences between private and public health insurance.
KSA Insurance helps individuals in South Carolina and across the southeastern United States find healthcare plans that meet their unique needs. Request a quote today.
Private Health Insurance Options
Private healthcare plans are provided by private companies and are typically paid for by individuals or their employers. These plans can be purchased for individuals or groups. Here are some of the primary private health insurance options:
If you can’t get health insurance through your employer, or you aren’t satisfied with your employer-sponsored plan, you may opt for individual health insurance.
Individuals can purchase health plans for themselves and their families directly from a private insurance provider. These plans may either reimburse you for the cost of medical services, or they may bill the healthcare provider directly for the services they perform. Depending on the level of coverage you choose, individual plans may or may not be more affordable than employer-sponsored insurance.
Employer-Sponsored Health Insurance
Many employees throughout the United States obtain health coverage through their employers. The Affordable Care Act of 2015 made it so that employers with at least 50 full-time employees may face tax penalties if they don’t provide health coverage, making employer-sponsored health insurance a more common employee benefit.
These health plans are often more affordable than individual policies and can cover employees and their families. The primary concern with this option is that employees may be paid lower wages to compensate for healthcare policy costs.
Public Health Insurance Options
Public health insurance policies are subsidized by the government and intended primarily for low-income families, low-income individuals, and elderly citizens. Here are some of the primary public health insurance options:
Medicare is a federal public health insurance program designed for people ages 65 and older, people with certain disabilities, and individuals with end-stage renal disease. Medicare includes four parts, called Part A, B, C, and D:
- Part A covers home healthcare, hospital visits, skilled nursing facilities, and hospice services.
- Part B offers coverage for outpatient services, preventive care, doctor visits, and medical supplies.
- Part C is offered by private insurance providers and includes Parts A and B.
- Part D covers prescription drugs and is run by private insurance providers.
Medicaid is a public healthcare program that’s administered by states and jointly funded by federal and state governments. The program is designed for low-income individuals and families and covers children, people with disabilities, pregnant women, and elderly individuals.
Each state has its own eligibility guidelines for its Medicaid program. These guidelines typically relate to family size, income, disabilities, pregnancy status, and similar factors. On top of eligibility guidelines, states also determine how much coverage is provided to participants and how much they must contribute.
Public Insurance for Special Groups
While Medicare and Medicaid are the two most common public health insurance programs, there are other programs designed for special groups that do not qualify for Medicaid or Medicare:
- Children’s Health Insurance Program (CHIP). CHIP is a state and federally-funded health insurance program that offers coverage to uninsured children and families who don’t qualify for Medicaid and can’t afford private health coverage. Like Medicaid, eligibility requirements, participant costs, and coverage are determined by states.
- Veteran Affairs. The United States Department of Veteran Affairs provides health insurance coverage for military veterans and qualifying service members.
- Tricare. Tricare is a program run by the US Department of Defense that provides healthcare coverage for military service members, their family members, and some military retirees.
These public programs offer comprehensive healthcare coverage for those that may not be able to afford private health insurance and do not qualify for other public healthcare programs.Which is Right for You?
When determining whether private or public health insurance is right for you, there are several factors to consider, including your income, existing health conditions and disabilities, and other life circumstances.
Pros of private health insurance include:
- Policyholders can often choose their own doctor.
- Private hospitals are typically not as busy as public healthcare facilities, allowing you to get treatment more quickly.
- Policyholders can increase their coverage as needed to ensure all of their concerns are addressed.
- There are more plans to choose from.
Pros of public health insurance include:
- Plans are typically more affordable.
- Offers affordable coverage for individuals and their families.
- Includes options designed for special groups, including veterans, disabled individuals, and low-income families.
Ultimately, public health insurance generally offers more affordable coverage at the expense of less flexibility. If you don’t meet public health insurance eligibility requirements or prefer more flexibility, private insurance may be the better option. However, if you’re unable to afford private insurance, public programs will help ensure that you can access the healthcare services you need to remain healthy.
Request a Quote
Health insurance is a must-have, as it ensures individuals can access healthcare without incurring the full cost of the services they receive. At KSA Insurance, we work with most major insurance carriers to help clients find affordable, comprehensive health insurance policies that meet their needs and provide invaluable peace of mind.
Contact KSA Insurance today to request a quote and learn more about your health insurance options.