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Identifying and Understanding the Variance Between Private Vs. Public Health Insurance

The government provides public health care through national health care systems while self-employed practitioners and non-profit government providers offer individual health. Private health care is provided through insurance plans where enrollees sign up for different covers at a premium charge usually higher than state-run insurance plans.

It is the kind of insurance provided through employers and other organizations. Depending on the company’s resources, it may offer one or several types of health insurance covers. However, some employees may prefer signing up for their covers instead of getting a plan through their employer. Such programs cost higher as the employee foots the entire bill instead of sharing it with the company. Some private insurance plans work with particular health care facilities and providers that are part of the insurance plan to provide affordable care; a program called managed care. We will discussion the various kinds of managed care plans.

Preferred Provider Organization & Indemnity plans

The program allows clients to pay less if they use providers within the plan’s network as it pays most of the medical costs. However, clients visiting hospitals, doctors, or providers outside the network without referrals pay an additional charge.Private health insurance plans not listed under the managed care plans are called indemnity. Indemnity enrollees are not restricted as to their choice of doctors or medical facilities. The health care provider receives a fee each time you receive medical care covered by the plan.

Health Maintenance Organization

The insurance plan only takes care of medical assistance expenses within a particular network of health providers. It is an organization that provides managed care for self-funded health care plans, health insurance, individuals, and other entities working together with e health care providers on a pre-paid basis. As such, the policy limits coverage to care from doctors who have entered in contact with the HMO and only provides out-of-network care during an emergency. The HMO plan also requires subjects to work or live within the service area to qualify for coverage. Most such plans focus on integrated care, as well as prevention and wellness.

Point of Service & Exclusive Provider Organization

The program combines characteristics of the preferred provider organization and the health maintenance organization. The POS plan provides lower medical costs to its clients but offers a limited choice. Enrollees who have signed up for the program are required to choose a primary health care provider from within the network, which becomes a Point of Service. The primary health care provider can make referrals to facilities outside the network where the medical insurance plan offers little compensation. The required paperwork during medical visits within the health care network is completed on behalf of the patient. However, if the patient visits facilities outside the network, it is his responsibility to fill out the paperwork and send all the bills for payment. It is another managed care plan where medical services are covered under the plan only if the client visits a doctor, specialist, or a hospital within the plan’s network.

Public Insurance Identified As Medicare & Medicaid

This kind of program is classified into two broad categories: Medicaid and Medicare


It is state-run health insurance plan with a primary focus on people with low income. The program also covers older people, expectant women, and those with a disability. Rules about those eligible for the plan and the kind of services provided vary from one state to another. Medicaid pays the health care provider, but enrollees are required to pay a small amount for particular health services.


It is another public insurance program that focuses on individuals aged 65 or above. The plan also covers people with disabilities or long-term illnesses like kidney failure. It is divided into four parts:

  • Part A that helps cover care in particular medical facilities like hospitals and nursing facilities
  • Part B that helps pay for health care providers and special outpatient care. It may cover services not included in Part A plans like some physical therapy and home health care
  • Part C allows enrollees to enjoy health care coverage included in Parts A, B, and D through private health plans like PPO and HMOPart D helps clients meet prescription medicine costs. Patients with limited incomes also qualify for extra help with costs on prescription drugs