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Last Updated on March 27, 2024 by Insurdinary Editorial Team -->
Imagine having an accident at work or a long-term illness that puts you in the hospital for days or even weeks on end. Between worrying about your wellness, who’ll take care of your personal or at-home affairs, and when you can return to work, the last thing you want to think about is whether you can even afford medical care. That’s where private and public health insurance come in.
One visit to the hospital can cost tens of thousands of dollars that you would have to pay out of pocket without full or partial coverage. Rather than pay this daunting bill or take on the consequences of being unable to, we’ll break down the two main types of health insurance and why it’s essential to have the one that suits your needs best.
According to Forbes, about 8% of the American population, which averages 26 million individuals, still don’t have health insurance because of high insurance costs. However, one emergency service quickly paves the way for large medical debt. You’ll be responsible for the balance of whatever treatment you receive, which you may be unable to pay yourself.
As your balance rises with hospital stays, prescription drugs, and surgeries and other procedures, you could undergo wage garnishes and lawsuits. In extreme cases, filing for bankruptcy may be the only way to rid yourself of the outstanding costs. These drawbacks affect mental health, sometimes causing relapses in illnesses like strokes and heart attacks brought on by high blood pressure, harming your well-being.
Unfortunately, these are far from the only public health concerns. A Health Care Affordability Survey by the Commonwealth Fund uncovered that about 38% of U.S. citizens held off picking up their prescription drugs or visiting their primary care physician for symptoms or pain they’ve noticed. Fears of high costs jeopardize their wellness and ability to reach out for and receive help.
The 38% of individuals who opt out of health insurance usually come from low-income communities, and, according to the Office of Disease Prevention and Health Promotion, over half of this uninsured population stems from minority groups. These uninsured individual adults find it hard to receive preventative and treatment care for chronic conditions, including the following:
Children who come from these low-income or minority families have it no easier since they also often forego treatments because of their financial situations at home. They have a higher risk of asthma and other illnesses with little to no dental care and preventative treatment options, which could cause ailments to worsen as they reach adulthood. We want to avoid this vicious cycle.
Well-insured populations, on the other hand, mean that most or all individuals in that community receive the medical preventative and treatment care they need, ensuring their optimal health and well-being. Health industry also receives knowledge and understanding of current health concerns in the country and issues affecting large percentages of people so they can help with community wellness strategies.
These community health initiatives include:
More awareness of individual health equals more public health awareness since your protection means there’s less chance of diseases spreading from one individual in your community to another. It also means you lower your children’s risk of developing hereditary illnesses since screenings allow you to catch these diseases in you or your children during the early stages.
Therefore, with health insurance encouraging you to visit your healthcare provider regularly, you can inspire a healthier community and future generations.
Now that you understand the importance of health insurance, let’s look at the two types of health insurance you can choose from: private and public. While the primary differences between the two are affordability and qualifications, we’ll delve more into what separates them and which is best for you, depending on your needs.
Medical insurance compensates expenses or fees caused by injury or illness. Public health insurance is, more specifically, the compensation you receive from the U.S. government for most medical circumstances that could arise. According to a report published by the National Academy of Sciences, population health programs available with public insurance include the following.
Medicare comprises four parts, the first two parts (A and B) covering most medical and standard hospital fees at state and federal levels. Part A covers in-patient expenses like hospital and hospice care alongside skilled nursing facility care, while Part B covers out-patient and preventative services.
Those 65 and up automatically enroll in these two parts, but those with disabilities or End-Stage Renal Disease can also qualify.
However, Medicare Parts C and D are optional coverage options only private insurance companies offer via their contracts with the federal government. While Part C provides supplemental coverage for high-costing copayments and deductibles, Part D offers premium prescription drug coverage.
State-level administered Medicaid, like Medicare, also covers those with disabilities and older adults. However, they also assist low-income families and individuals alongside pregnant women who feel they can’t afford private insurance. Some mandatory coverage you’ll receive with this public health advocacy program includes:
The Affordable Care Act (a.k.a. Obamacare) requires employers since 2010 to provide employee insurance to 95% of their 50-plus full-time employee staff. Because of this, ACA helps those in the workforce receive coverage via their jobs. Still, some low-income individuals or families just above the financial hardship curve may receive IRS penalties if they don’t pay for ACA insurance coverage.
However, if you have religious belief complications or enroll for Medicaid, you may be able to meet the requirement to opt out of ACA if it’s not right for you.
Private health insurance is the coverage you receive from a privately owned company rather than the state or federal government. With private insurers, an employer or union covers their employees, or individuals cover themselves and their families. This coverage may stand on its own as your only insurance, or you can use it as additional coverage on top of your public insurance.
Either way, unlike public health insurance, you’ll pay out of pocket for a portion of your medical bills and any in-patient or out-patient services. Available private health insurance options include the following.
Health maintenance organizations (HMOs) offer you a lower premium rate than other private health insurance coverages. That’s because you’re using HMO-network medical professionals, but this lower price point also means fewer choices regarding what doctors or facilities you can use. You also need a primary care physician to recommend in-network services, depending on your concerns.
Preferred provider organizations work similarly to HMOs because they provide a certain level of coverage on in-network medical services. However, PPOs have a slightly higher cost for coverage since they also allow you to use out-of-network medical facilities and professionals, granting you more choices and higher flexibility. Also, unlike HMOs, you don’t need a PCP as part of your PPO plan.
Point-of-service plans are a combination of HMOs and PPOs. For instance, POS plans allow you to seek coverage out of network like with PPOs, giving you more options than HMOs. However, POS plans also require visiting your primary care physician before qualifying for an in-network or out-of-network medical facility, just like HMOs.
As you already know, you can only receive Medicare Parts C and D via a private insurer. Medicare Supplement plans like Medigap also allow you to apply for extended coverage through a private insurance company if your original Medicare plan doesn’t fully cover your needs. By paying for your original Medicare premium alongside Medigap (as long as you’re 65 and older), you’ll get:
Insurance rates are not cheap, and with plenty of options, it’s sometimes difficult to find one that suits your needs and budget. That’s why at Insurdinary, we try to make it easy for you by comparing your options side by side.
So, whether you want to learn about public health interventions or global health initiatives in your area or want to switch coverages, contact Insurdinary and receive a quote today!