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Private Health Insurance

Private health insurance is purchased through a for-profit provider, rather than administered through governmental agencies, as is public health insurance such as Medicare or Medicaid. And unlike public health insurance, which is generally available to anyone over a certain age or in a certain income bracket, private health insurance is available only to applicants who meet the company’s eligibility requirements.

Before purchasing private health insurance, applicants usually must complete a comprehensive medical and lifestyle questionnaire. Questions range from if the person smokes to how much they weigh to any diseases they suffer from. They may receive discounts if they practice certain healthy behaviors, or may be denied if they suffer from pre-existing medical conditions.

There are two types of private health insurance: group coverage provided by an employer, and individual or family coverage purchased by the individual. With employer plans, the coverage is purchased through the employer, and a single insurance provider is used, but each employee may be able to choose from several plans or customize plans to meet their needs. Individual coverage is purchased directly through the provider.

Private health insurance is usually purchased year-to-year, with no guarantee that it will be renewed or that the premiums will not increase. Private health insurance providers offer a wide variety of plans, and often, customers can customize the benefits and costs according to their needs. Under private health insurance, customers usually have a predetermined monetary amount, called a deductible, which they are responsible for and must meet before their expenses are covered. They also usually have a co-payment, or a portion of the doctor's office visit they must pay.

Private health insurance plans offer a variety of services, and frequently cover inpatient hospital services and surgical procedures, including the cost of diagnostic tests, nursing care, and room and board. They may also receive coverage for prescription eyeglasses, prescription medications, medical tests, ambulance service, and oxygen. Private health insurance providers usually only cover procedures they consider medically necessary, at charges that are reasonable and customary according to their guidelines.

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