What is the difference between Public and Private Insurance in the US?

What is the difference between Public and Private Insurance in the US

The United States of America is well known for its expensive health care system. Most of the international health insurance companies often exclude the US from their list due to this reason. It is not possible to live in a state like the US without a health insurance policy. But at the same time, you need to see it doesn’t make you empty-handed.

It is wise to go through all the possible options rather than blinding choosing what’s on the table. For this purpose, we have stated all the possible differences between public and private health insurance.

Public Insurance

Public insurance is provided by the Government of the US to people who need it. Only those who are jobless, disable, elderly qualify for public insurance. Public health insurances in the US are Medicare, Medicaid, and CHIP.


Medicare is provided by the federal government to seniors above the age of 65 and disabled people. The cost of Medicare is rising day by day because of the increasing population. The Affordable Care Act is taking steps to make it affordable for most of us.


Medicaid is mostly for those who cannot qualify for Medicare. It mostly covers low-income children as well as their families, if they are not able to work. The federal government as well as states fund Medicaid. The Affordable Care Act is expanding Medicaid so that more people can qualify for it. Usually, those under 133% income of the federal poverty qualifies for Medicaid easily.

Children Health Insurance Program (CHIP)

CHIP is a program which aims to aid children and their families who cannot qualify for either Medicaid or Medicare but at the same time cannot afford private insurance. This program was organized to fill the gap between Medicaid and private health insurance.

What are the Pros and Cons of Public Insurance?

Public insurance is more affordable. It comes with low premiums and you can ask for even lower premiums if your income gets reduced after some time. Insurance Aids like Medicare and Medicaid covers your complete insurance from day one till you die. This is usually for people either too old or disabled. In short, for those who cannot work at all.

Where there are so many pros of public insurance, one should not neglect its cons. Most private hospitals or clinics do not accept public insurance. But you must be thinking about why I even need a private hospital in the first place.

Well, public hospitals make you wait too long even for a little checkup. Sometimes you need the treatment as soon as possible, this is where private hospitals come in handy. If you do not have private insurance, you will have to pay big checks instantly which can put you in debt or even make you broke.

Private Insurance

Private insurance can either be bought directly from a private insurance company or provided by employers of big companies. It can either be purchased by a single consumer or on a group basis. More than 50% of Americans prefer and use private insurance over the public.

Private insurance, such as health insurance, life insurance, Final expense insurance, and car insurance are often quite helpful to citizens of the US. The most common is funeral insurance, that everybody needs.

Sponsored by Employers

Employers of big companies provide their employee’s easy health insurances to avoid tax penalties from the Federal Government. Obamacare in 2015, called out all the employers to give their employees with easy and affordable health insurances to avoid heavy tax penalties.

Employees over the age of 50 are given a complete A-Z health insurance, which covers all of their medical expenses. Private insurance sponsored by employers’ is the best health insurance policy because it is affordable like public insurance and secondly, all the public and private medical centres accept it.

Individual Private Insurance

Individual is opted by a single person for himself or one of his family members from a private limited insurance company. Individual private insurance does not involve any employer or third party. You are directly working with the insurance and have to pay the premiums yourself.

Premiums and insurance plans are different and unique for each person depending upon his needs, and affordability. Individual private insurance costs more than public insurances but less than group insurances.

Pros and Cons of Private Insurance

Private insurance is surely more flexible. You can visit any doctor or hospital in the United States with private insurance in hand. Moreover, private insurance is more affordable than group insurance. Private Insurance for each individual is more reliable and guarantees a quick response from most of the companies.

Other than all these pros, there are a few cons of private insurance as well. First, private insurance comes with hefty premiums which not everyone can afford. Second, private insurance is more likely to come with an expensive price tag which again could be unaffordable for some people.


Having said that, it is still up to you to make a wise decision according to your needs and affordability. If you are not in a situation to afford the monthly premiums of private insurance, then it is advised to take on public insurance.

But if you earn enough monthly income, and value standard of living, then surely private insurance is a better and peaceful option. We are a group of insurance agents serving people like yourself for years. We can help you further to decide. Fill the form and get in touch with our experts and know what’s best for you.