Health Care Vs Private Insurance 2023: What You Should Know

Healthcare and private insurance are two completely different things. Healthcare can be defined as the field that concerns the maintenance or restoration of the health of the body and mind. This goes on to affect or dictate the procedures related to the care of one’s physical and mental health.

Private insurance on the other hand is defined as insurance that compensates the insured for expenses or losses incurred for medical reasons, such as illness or hospitalization.

In this guide, we’ll highlight all you need to know about health care and private insurance.

What Is Healthcare?

Healthcare is defined as the field concerned with the preservation or restoration of physical or mental health. This includes any techniques or methods for dealing with a person’s physical or mental health.

Healthcare is provided by doctors, nurses, dentists, therapists, hospital systems, and pharmaceutical companies. The prices these providers set for their products and services are the primary driver of health insurance costs.

The duties of healthcare professionals include diagnosis, treatment, and prevention of diseases. The term healthcare is not just limited to traditional medicine. It also covers areas like dentistry, optometry, pharmacy, nursing, allied health, and similar areas of health.

Professional healthcare experts offer patients the best treatment for their illnesses and ailments, through the administration of necessary guidance or treatments for preventing illness and disease in the future.

Types of Healthcare

1. Primary Care

The most well-known sort of care is primary care, in which you visit your doctor to discuss your symptoms and medical concerns. In addition, primary care is in charge of coordinating your care with specialists.

2. Secondary Care

Once you have been referred to a specialist by your healthcare provider, you are in secondary care. This means that you will be cared for by someone who has expertise in the field in which you are having health problems.

3. Tertiary Care

If a patient’s issue gets to a stage where he/she needs hospitalization, he or she may be referred to tertiary care. This type of care requires specialized expertise and equipment.

4. Quaternary Care

Quaternary care is an extension of tertiary care. It is highly specialized and therefore only offered by certain providers and hospitals.

5. Home and Community Care

This type of care refers to a wide range of health services designed to meet a person’s medical needs, such as skilled nursing care, dietary management by a dietician, and occupational, physical, or speech therapies.

6. Urgent Care

Urgent care centers provide patients with swift access to healthcare at times when their normal healthcare provider may not be available. They are usually open during non-business hours, such as nights, weekends, and holidays.

Private Health Insurance Definition

Private insurance refers to any health insurance coverage that is offered by a private entity instead of a state or federal government. Insurance brokers and companies both fall into this category.

Some private health insurance policies include benefits that meet the Affordable Care Act’s essential coverage standards (also known as Obamacare). Different advantages, including short-term or catastrophic coverage, may be available with other plans. These plans, like short-term plans and catastrophic coverage, may not qualify as eligible health plans under the Affordable Care Act, despite the fact that they may provide distinct benefits.

Private health insurance firms help with the financial aspect of paying for treatment. While health insurance is a part of the “business” of medical treatment, it is not the same as healthcare.

Who Funds Private Insurance Companies?

Private insurance companies are provided primarily through employer-sponsored plans; examples are Blue Cross and Blue Shield plans, non-Blue commercial plans, HMOs, and self-funded employer plans.

Private health insurance is primarily funded through benefits plans provided by employers.

Examples include:

  • Blue Cross and Blue Shield health insurance companies
  • Non-Blue commercial health insurance companies
  • Health Maintenance Organizations (HMOs)
  • Self-funded employer-sponsored benefit plans

Employees opt to engage in their employer-sponsored health insurance plan in order to get coverage. They pay a higher price. In exchange, customers obtain an insurance card that grants them access to the insurance plan’s doctors, hospitals, and other healthcare providers.

Types of Health Insurance

Here’s a list of the types of health insurance:

1. Basic Medical Insurance

This type of insurance offers less coverage with the tradeoff of lower premiums. After paying a premium for coverage, members receive sufficient funds to reimburse them for events such as doctor visits, surgery, and lab tests.

2. Major Medical Insurance

Major medical insurance generally covers more than just doctor appointments and surgical procedures. These plans go further to cover other services like physical therapy, nursing home care, and rehab, as well as prescription drug costs.

3. Supplemental Medical Expense Insurance

Supplemental medical expense insurance is designed to assist you to pay for services and other out-of-pocket expenses that your insurance company will not pay for.

4. Disability Income Insurance

This type of health insurance provides eligible disabled individuals who are not able to work with periodic payments of benefits. With this type of insurance, 45 to 65 percent of a person’s gross income is substituted on a tax-free basis.

5. Long Term Care Insurance

Long-term care insurance caters to expenses associated with long-term care. It often covers care that is not otherwise covered by Medicare or Medicaid.

6. Critical Illness Insurance

Critical illness insurance provides you with a lump sum of money if you are diagnosed with certain illnesses or disabilities. It provides extra coverage for medical emergencies like heart attacks, strokes, or cancer.

7. Hospital Cash Insurance

Hospital cash gives you cash compensation when you are hospitalized, protecting you against the loss of income. It provides financial protection by giving you daily cash benefits throughout your stay in the hospital.

What Are The Advantages Of Private Insurance?

There are definite benefits of private health insurance. Here are the key advantages you may want to consider:

1. Reduced waiting times

The fact that public hospital waitlists can be so long is one of the many benefits of private health insurance. Members with private health insurance can essentially ‘jump the queue’ by scheduling their medical procedure in advance, rather than waiting for the next open place and risking having their procedure pushed back.

2. Freedom of choice

Private health insurance affords you a greater choice when it comes to the treatment you receive, where you receive your treatment, and who performs your surgery. You also have the chance to choose your doctor should you be admitted to the hospital. It’s important to note that these extras are subject to availability.

5. Select your doctor or surgeon

Private insurance gives the insured the freedom to select their preferred doctor or surgeon to carry out an operation. In a public hospital, your doctor will be the one on duty at the time of your operation.

As with the availability of a private room, your preferred doctor or surgeon is still a matter of availability in the private system.

3. Access to private hospital rooms

Another benefit of private health insurance is the ability to be treated and/or recover in the privacy of your own room. Private health insurance, unlike public health insurance, allows members to request their own room. However, this amenity is subject to availability.

4. Greater coverage

Private insurance gives you greater coverage. For instance, you may be covered for health services that aren’t offered through the Medicare scheme. This can range from dental and optical work to psychological, physiotherapy, and podiatry consultations.

5. Pay less tax

If you have private health insurance, you might not have to pay the Medicare levy surcharge (MLS). The MLS promotes people with greater earnings to purchase private health insurance, which relieves strain on the public health system. It is a tax of up to 1.5 percent of taxable income imposed on those who do not have private hospital insurance (for themselves, their spouse, or dependent children) and earn more than a particular amount.

Are There Disadvantages of Private Insurance?

Here are some of the reasons why people might choose not to take out private health insurance:

1. The cost

Private health insurance is costly; depending on the coverage, a person, couple, or family could pay thousands of dollars in premiums each year, with rates rising annually.

2. You aren’t guaranteed coverage for your treatments

Private insurance doesn’t guarantee coverage for your treatment. This factor depends on your policy. If you require treatment in a hospital, chances are that you aren’t covered for that specific treatment.

Before you invest, ensure you research and come up with a policy that best suits your health history and future needs.

3. Excluded treatments

Depending on the policy, if you end up needing treatment in hospital, you might still not be covered. Even a comprehensive policy may not cover every type of treatment or procedure.

4. Out of pocket costs

A private health insurance policy covers part of the cost of a treatment or procedure. This entails, you may still end up paying a substantial amount in excess.

Health care Vs Private Insurance

Public health insurance is a choice for some Americans and they provide the following options:

  • Medicare, a federal program for adults over the age of 65 and certain disabled individuals.
  • Medicaid, a state-run public health insurance program for low-income individuals.
  • The Children’s Health Insurance Program (CHIP), a subset of Medicaid, which offers subsidized low- or no-cost health insurance for children.

Eligibility is one distinction between public and private health insurance. Age and income are both qualifying factors for public health insurance alternatives. You can acquire private health insurance if you don’t qualify for Medicaid, and eHealth can help! We provide expert brokers to assist you in locating plans in any state, as well as a large range of plans and services to assist you in managing your healthcare coverage.

FAQs On Private Insurance

When can I buy private health insurance?

Most types of health insurance have an open enrollment period during which you can sign up for private health insurance. This is true whether you buy insurance via the Affordable Care Act (ACA) health insurance exchange in your state, sign up directly through the insurer, enroll in the plan that your employer offers, or sign up for Medicare.

What does private health insurance cost?

In 2020, the average national cost for health insurance was $456 for an individual and $1,152 for a family per month. However, this cost can vary considerably depending on your healthcare needs, the state where you live, and what level of coverage you require.

Why do I need private insurance?

Private insurance plans are intended to protect their beneficiaries from the high costs that may be incurred for health care.

Is private healthcare subsidized by the government?

Yes, in most cases. Employer-sponsored health insurance is subsidized via the tax code, as it’s typically offered as a pre-tax benefit for employees. 


In a nutshell, health insurance is a form of insurance that pays for medical treatment. It will be private health insurance coverage if you purchase health insurance. This means you’ll have to pay monthly premiums to cover hospitalization and/or ancillary treatments like vision and dental care, as well as some allied health services like physiotherapy.


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