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What is Private Health Insurance?

Private health coverage refers to health insurance sold and administered by private health insurance firms. Unlike public health insurance plans like Medicare and Medicaid, private plans are not regulated by the national government.

Public vs. Private Health Insurance

CHIP, Medicaid, and Medicare are some public health insurance alternatives available to Americans. Medicaid is a government-funded healthcare program for low-income people. Medicare is a program for people over 65, whereas the Children’s Health Insurance Program is a Medicaid subsidiary that provides health insurance to children.

Eligibility is one distinction between public and private health cover. Age and income are both qualifying factors for public health insurance alternatives. During the open enrollment period, qualified Americans can enroll. A qualifying life event, such as the birth of a child, a relocation, or an involuntary loss of coverage, may qualify you for a special enrollment period into public health insurance. If you do not qualify for government-sponsored health insurance, private health coverage is still a viable choice. FirstQuote Health is there to provide you with quotes and professional advice for your best plan.

How Private Health Coverage Works

You must request insurance and undergo an endorsement process with private health coverage firms. The underwriting process decides how much the company will be liable to you, whether you will be accepted or denied for coverage, and how much coverage will cost you.

Once you’ve been authorized for coverage, you’ll have to pay a premium every month. Your premium is what keeps you covered; if you skip a payment or don’t pay in full, your insurer could withdraw you from the health insurance plan.

Except for a few medical services, your premium does not cover everything right away. Your insurance usually covers preventive care, wellness exams, and some accepted medical treatments, but most medical procedures will need to pay out-of-pocket.

Before your medical expenditures are covered, most private health insurance plans require you to pay a deductible. Other out-of-pocket fees, such as coinsurance and copays, are commonly included in plans, and you may be responsible for them even after your deductibles have been met.

Types of Private Health Coverage

Health Maintenance Organizations (HMO)

HMOs require you to choose from an internal network of cooperating hospitals, doctors, and other medical professionals and facilities. You must also select a primary care provider (PCP) within the network for these health insurance plans.

Your primary care physician (PCP) is your medical home base who gets to know you and assists you in coordinating all of your medical care. They’ll also need to send you to one of their in-network specialists. Provided you stay in-network, the costs of an HMO plan, including copays and coinsurance, are often lower than those of other types of health plans.

Preferred Provider Organization (PPO)

Because you do not need a referral from a primary care physician to see a specialist, you may have more flexibility to choose your healthcare professionals with a PPO than with an HMO. Compared to in-network physicians, out-of-network doctors have greater out-of-pocket expenditures.

If you visit out-of-network providers, PPOs require more paperwork than other plans. PPOs usually feature a vast network of participating providers so that you can choose from many hospitals, doctors, and other healthcare professionals and facilities. With these plans, you also don’t have to choose a PCP.

Exclusive Provider Organization (EPO)

An EPO provides you with a network of coordinated providers from which to pick. Except for emergencies, most EPO plans do not cover out-of-network care. Therefore, if you visit a physician or facility outside of the plan’s local network, you will almost certainly be responsible for the entire cost of services.

The plan decides whether or not you will be required to select a primary care provider(PCP). You don’t need a recommendation from your PCP to see a specialist in your network. EPOs have lower premiums than a PPO provided by the same company.

Point of Service Plan (POS)

HMO and PPO elements are combined in point of service plans. In comparison to a PPO plan, the network for the provider is often smaller, and the rates for in-network treatment are typically lower. If you have a POS plan, you must also select a primary care provider (PCP) from the plan’s network of physicians and other primary care professionals. Your primary care physician (PCP) is your go-to person for care and guidance. The PCP study you and your medical needs, and they can assist you in coordinating your care.

You must obtain a reference to see a specialist. You can choose to see specialists in-network or out-of-network, just like a PPO. If you go to a doctor who isn’t in the plan’s network, your expenses will be greater, and you’ll have to file any claims yourself.

Example of a Private Health Cover

You enroll in a health insurance plan that meets your needs and matches your budget. You select a $300 monthly premium plan with a $2,500 annual deductible. Furthermore, each time you arrange a doctor’s visit, you must pay a $25 copay.

You get sick with the flu a few weeks after your medical insurance kicks in, and you spend a few days in the hospital filled with water and medicine. When you leave, you’ll feel revitalized and relaxed, ready to face the day’s challenges.

Your medical practitioner sends you a note as time passes. When you look at the bill, you notice that your hospital stay cost you $15,000. However, since you have a low deductible plan, you only pay for your deductible, and your insurance will cover the remainder. So, even if your bill is $15,000, you will only have to pay your deductible, which is $2,500.

When you pay your deductible, your health insurance will cover all of your medical expenses until your deductible refreshes, which normally happens once a year. Your copay will still be due, and you will be charged a $25 fee for your next doctor’s appointment.

Pros and Cons of Private Health Coverage

Private health insurance plans have their advantages and disadvantages. For a comprehensive overview of the pros and cons of private health insurance plans, you can learn more here.


  • When it comes to medical professionals, you’ll have more options, including the possibility to choose your doctor.
  • You will generally have lower wait times when you have private health cover.
  • You will be able to use amenities of a better standard.


  • Private health coverage may be more expensive.
  • The health insurance marketplace does not provide you with the ability to qualify for subsidies.
  • Plans that do not fulfill federal criteria may result in a tax penalty.

How Much Does Private Health Insurance Cost?

In 2020, the average monthly premium for private health coverage was about $456. These private plans also had deductibles that were roughly the same amount. Following the initial stun of the sticker price, it’s worth noting that these figures may be well below what you’d pay if you didn’t qualify for subsidies through your local health insurance marketplace.

Affordable Health Insurance Options

Catastrophic Coverage

Catastrophic coverage offers lower premiums, three primary care visits before the deductible kicks in, and free preventive care, even if the deductible hasn’t been met. Catastrophic plans are best for young people, particularly those under 30. In 2020, a catastrophic health plan had an individual deductible of $8,150 and a family deductible of $16,300. After you’ve met your deductible, the plan will cover all your medical expenses.

Short-Term Health Insurance Plans

Short-term health insurance protects you from costly medical expenditures incurred due to unforeseen health changes or crises while your permanent coverage lapses. If you lose your employer-sponsored health insurance, go to an out-of-state college, move jobs, or are waiting for the open enrollment period, you may be entitled to short-term health insurance.

Long-term health insurance plans often provide more coverage than temporary insurance plans. They do, however, offer emergency coverage to those who are unable to acquire an ACA-compliant plan or who require temporary coverage until their long-term health insurance plan kicks in.

Alternatives to Private Health Coverage

Regardless of the huge role that healthcare insurance offers, many freelancers are still looking for options. There are few options available for people outside the public health insurance plans who do not want to enroll in private insurance. Some options are medical cost-sharing, indemnity insurance, care memberships, discount cards, and paying out of pocket.

What is the Best Private Health Cover?

Top-Rated Health Companies

The appropriate firm for you will be determined by your requirements. Kaiser Permanente and Blue Cross Blue Shield both have great ratings for comprehensive coverage at an affordable price. If you’re in good health, you might want to go with a low-cost alternative like Molina, which has mixed reviews but can save you money if you only visit the doctor a few times a year.

HMO vs PPO Plans

You should choose a PPO plan if you want greater flexibility at a higher expense. You should choose an HMO plan if you desire less flexibility but the chance to save money.

Both HMO and PPO plans allow you access to a network of providers at discounted rates. On the other hand, PPO plans do not require a recommendation from your primary care physician to see a specialist, whereas HMO plans do. If you stay in-network with your HMO plan, on the other hand, you may not have to pay a deductible. It’s best to consult with a real estate agent or broker to determine which choice is best for you.

Who Should Consider Private Medical Insurance

It is something that everyone should consider. These health insurance solutions might save you money while still providing the required coverage. If you missed Open Enrollment or don’t have health insurance, you should look into private health coverage. Private insurance may be an option if you don’t have coverage, don’t qualify for special enrollment, or can’t locate a suitable plan through the marketplace.

Get a Private Healthcare Coverage Quote

With the stroke of a mouse, FirstQuote Health makes searching for private health coverage easy by displaying the finest quotes in your area. Find out which plans are right for you and within your budget, and even speak with a real representative. Don’t walk alone anymore.


Is it possible to get free private health insurance?

There is no such thing as free insurance in the private sector. It’s vital to remember that “free” healthcare isn’t necessarily free. Citizens indirectly fund the healthcare provided by government agencies. All government activities, including healthcare, are supported by their taxes. However, affordable private health insurance is available.

Is everyone eligible for private health insurance?

If you have a pre-existing condition, you may lose your eligibility for some private health insurance plans. Although, there are private health insurance companies that will accept everyone, so there will most likely be a private health insurance option for you.

Where can you buy private health insurance?

Private health insurance can be purchased through the health insurance marketplace, or outside the marketplace. Unless you are enrolled in a public health insurance plan like Medicaid or Medicare, you can safely assume you are enrolling in private health insurance.

Is private health insurance always more expensive?

No, private health insurance isn’t always more expensive. In fact, if you don’t qualify for government subsidies, buying private health insurance outside the marketplace can save you money.

Will private health insurance exempt you from the tax penalty?

If your private health insurance plan meets all the federal standards that would make it a qualified health plan, then yes, private health insurance can save you from the tax penalty. If you buy private health insurance plans that do not cover the minimum essential benefits you may still have to pay a tax penalty.