State Versus Private Insurance

The Differences May Surprise You

State Versus Private Insurance

Regardless what type of insurance you have, you are better off than with none at all. However, the kind of insurance you have, and the type of coverage does make a difference.


Cost

The biggest difference between public and private insurance is probably the cost. Government insurance policies like Medicaid and medicare are accessible based on age and income. These insurance programs are cheap or free. Medicaid is available to low-income families and the disabled. Medicare is available to individuals of 65 years and older or suffering from a select few illnesses. Depending on the circumstance, there may be a co-pay for certain procedures or a "spend-down" that is the patient's responsibility. You can learn more about public insurance here: www.cms.gov.

Private insurance is usually offered through an employer, and it's up to the employer what type of plan is offered. This type of coverage is cheaper because it is a group insurance, offered at a lower rate because more people are covered. Choosing to buy health insurance yourself costs more, can be more difficult, and can be confusing.


Coverage

Government insurance usually covers preventive care (immunizations and well visits) as well as necessary treatments (hospitalizations and procedures). Elective surgeries are not covered under public insurance, and in some cases preventative treatments may be denied. Public hospitals and clinics accept state coverage, but Medicaid may be declined at private practices.

Private insurance policies vary, and coverage depends on what you're willing to pay. Types of plans include: fee-for-service, Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMO), as well as catastrophic and disability insurance. When it comes to private insurance, your coverage will often depend on whether your physician is in the network. Choosing a practitioner within your insurance network will also save you money.


Accessibility

The problem Americans are facing today is the accessibility of insurance. Medicaid is for those of low-income. Medicare is for the elderly or disabled. Employers don't offer insurance unless you work full time or have worked for a specific amount of time, and private insurance is often expensive to the point of exclusionary. A young person just out of high school or college cannot afford insurance, nor do they have a job that offers insurance. Both private and public insurance can be difficult to access.


Prescription Drug Cost

Depending on your coverage, you may be looking at paying out of pocket for select medications. If you're purchasing private insurance, you have more freedom to choose a plan that covers certain name brand drugs and has less of a co-pay. Many consumers will choose an insurance plan without giving prescription coverage a thought. This can be a disaster if they ever need to use it! However, your insurance plan may cover your medication when you choose it, and then drop the medication or brand name. Medicaid programs in all 50 states currently cover outpatient prescription drugs--usually the generic brand--and works with drug manufacturers to continue this coverage.

Choosing insurance coverage is not just about what you need here and now. It's about preventing and preparing for what you may need in the future. The cost, accessibility, and prescription coverage will depend on what type of plan you choose, and if you're using public or private insurance.

 

State Versus Private Insurance

Meet the Author:

Rachel Ashworth


Rachel Ashworth is originally from the Midwest, her expertise is writing research-based articles about health and wellness. Specific interests include mental health and addiction. Rachel has written on a wide range of topics including parenting, fitness, health, fire safety, home maintenance, medical insurance, and dental care. She spends her time writing, volunteering with her church and community, and teaching her children.


Rachel Ashworth is originally from the Midwest, her expertise is writing research-based articles about health and wellness. Specific interests include mental health and addiction. Rachel has written on a wide range of topics including parenting, fitness, health, fire safety, home maintenance, medical insurance, and dental care. She spends her time writing, volunteering with her church and community, and teaching her children.