Difference Between Public and Private Health Insurance

Difference Between Public and Private Health Insurance | healthGDS.com
One of the most common questions people have about health insurance is, "What health insurance plan is right for me?" Two of the terms you may have heard regarding health insurance is private health insurance and public health insurance. We'll take a look at what exactly these two types of health insurance plans are, the differences between public and private health insurance, and how to determine which plan is right for you.

Public Health Insurance

Public health insurance plans are plans that are in some way provided by the government. These plans are available to low-income individuals or families, the elderly, and other individuals that qualify for special groups. Public health insurance is insurance that is subsidized or paid for entirely by public (government) funds. Private health insurance is paid for in part or entirely by the individuals being covered. Several different public options are available in each state, but strict eligibility requirements exist. Private health insurance can be offered through an employer or can be purchased by individuals.

However, the public health insurance is not recommended for everything. Dental treatment, even a simple check-up or clean, is not covered by Public  health insurance. If you don’t have private health insurance, and you are not eligible for the public clinic, your only option would be to pay in full for dental treatment.

Advantages and Disadvantages of Public Health Care System

Advantages of public health care system

  • Overall more affordable than private health insurance plans
  • May also qualify for assistance with other expenses
  • Many plans require no co-pays or deductibles

Disadvantages of public health care system

  • Less flexibility to choose providers
  • Many providers do not accept government-sponsored health insurance plans
  • Limitations on covered treatment though they may be deemed necessary

Private Health Insurance

Private health insurance gives you the peace of mind of knowing that you and your family will be covered, should any health problems crop up that need treatment in the private system.
Many different private health insurance companies offer coverage in the United States. Cost and services covered by private health insurance vary greatly by region, company and plan. Plans may reimburse you for the cost of health care services after you receive them or may require you to go to participating providers, who bill them directly. Your plan may cover all of your costs or may require you to contribute a co-payment with each service.

What is Covered by Private Health Insurance?

Private health insurance plans are provided by private companies, such as an employer or other private insurance company. Currently, a majority of Americans receive their health coverage through private health insurance plans.
Private health insurance cover is generally divided into hospital cover, general treatment cover and ambulance cover. Ambulance cover may be available separately at private health insurance, combined with other policies, or in some cases is covered by your state government.

Advantages and Disadvantages of Private Health Care System

Advantages of private health care

  • Ability to choose your own physician
  • More plan options available
  • Wider network of providers to choose from

Disadvantages of private health care

  • Generally more expensive than public health insurance
  • Must pay monthly premiums whether you use services that month or not
  • Better coverage and more flexibility means higher payments

Difference Between Public and Private Health Insurance

The main difference is that public health insurance pays for patients to be treated in the public health system and private health insurance pays for patients to be treated in the private health system.
Differences between public and private health insurance include how much patients pay for treatment (the gap between doctors’ and hospitals’ fees and the benefit from insurance), how long they wait for treatment, what doctor treats them, and even what they pay in tax each year.

Having private hospital cover means you can choose whether you want to be treated as a private or public patient. If you go to a public hospital, you’ll be asked to sign a ‘patient election form’, which tells the hospital whether you want to be admitted as a private or public patient.

But, having private health insurance doesn’t mean that you can’t or shouldn’t ever go publicly. You have the right to be fully covered by Medicare as a public patient if that’s what you choose. Whatever you choose, the hospital and your doctor should tell you what your out-of-pocket costs will be before you’re admitted (this is called informed financial consent).
It’s important to keep in mind that any restrictions or exclusions on your cover still apply if you’re admitted as a private patient in a public hospital.

At the end, it's important to explore all of your health insurance plan options. It's also important to note that not everyone will qualify for public health insurance plans and obtain coverage through the private sector may be the way to find a plan for you and your family. Regardless of the stigmas surrounding both private and public health insurance options, both will protect you and your family from expensive medical bills.

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