Private Health Cost Insurance in the USA

Private Health Insurance

Health care in itself is a discourse overwhelmingly common in every household seeing as Americans currently pay $3.4 trillion per year in lieu of medical services. Under the current state of law, health expenditures are projected to grow at an average annual rate of 5.6% from 2016-2025, representing 19.9% of GDP by 2025. This extremely rising cost of health insurance premiums in the USA has become a significantly noticeable issue.

To gain a better understanding, one simply needs to glance at the Kaiser Family Foundation report. As that outlines the average cost of health insurance premiums for a family has risen from $5,791 in 1999 to a much steeply escalating $13,375 in 2009. Even the average cost of a single health insurance premium increases from$2,196 in 1999 to $4,324 in 2009.

Without taking into account any additional co-insurance responsibilities, whilst roping in co-pays and deductibles, most insurance plans now require co-insurance payments. This dictates that despite meeting your deductible requirement, you continue on paying a percentage of all the costs.

According to eHealth Insurance, in 2016 unsubsidized (private consumers), paid $321/month for individual premium coverage. While the family plans average a sum total of $833/month. The average annual deductible for an individual plan rounded up to $4,358 while family plans ended at $7,983.


In itself, Private health insurance and medical care comprise of insurance plans that are financed via private health premiums. These premiums are essentially agreed on payments made by a policyholder in exchange for coverage under a particular insurance policy. These insurance policies normally include a contract that is drawn up and issued by an insurer like Crea-MeD, Private Medical Clinic in Montreal, to the coverage consumer.

Now it is important to grasp the concept that Private health insurance is usually taken up voluntarily. However, this isn’t always the case every time. In some organizations, the company policy and working conditions entail it to be mandatory for employees to take up a private heal insurance scheme as part of compliance. This type of health insurance is completely unrelated to any income equation.

If private health insurance is procured by a specific population group or in general, by the mainstream majority population, the government can choose to subsidize it. At the end of the day, the pool of private funding is not channeled, administered or regulated by governmental entities, even when the insurer is a government-owned institution.

Private health insurance encompasses a wider variety of services. Crea-MeD, for example, provides general medicine services whilst operating outside the Quebec health care plan. They offer a multi-faceted range of customized, on-site services in collaboration with credible and reputable partners.

These services include Psychology, Family medicine, Ear cleaning, Private laboratory services, Check-ups, and consultations. Also included are vaccinations, Genetic profiling, Screening and treatment of disorders, Menopause and andropause treatment, Treatment for erectile dysfunction, Screening for sexually transmissible.

Moreover, it covers blood-borne infections like STBBI and STDs and Liquid-based Pap tests (vaginal cytology) and HPV screening.

On a more universal level, private health insurance covers employer self-insured health benefits i.e. an employer self-insured health coverage rather than purchasing a cover from an insurance company. In this situation, the employer takes upon the role of the insurer. Assuming all the insurance risks and costs associated with the medical field. Embarking on this path means the employer is subjected to the same regulatory requirements as other health insurance providers are.

Most often coverage includes inpatient treatment, emergency care, cancer treatment, outpatient consultations, diagnostics e.g. X-Ray imaging, optical and dental care, prescribed medicines, maternity care, preventative treatment, and checkups, etc. There are some insurance organizations that offer add-on packages allowing you to personalize your plan in accordance with your healthcare needs.

In extenuating circumstances, there are special schemes constructed for government employees. In this situation, the government entity enacts the role of an employer. They end up paying a designated percentage of the whole premiums of private insurance cover subscribed for its employers at the time.


An insurer solicits their payments in a number of ways:

1. Premium:

This is a monthly premium paid by the individual or their employer.

2. Deductible or excess:

Technically this is the amount that the insurer will not be providing and can be applied to either one person or a whole family. The benefits of the policy normally activate after the spending of a certain amount of financial expenditure on treatment costs.

3. Co-payment:

The customer pays a fixed amount for each type of cover type of treatment. In the US normally, visiting a primary care physician will have a compulsory co-payment of at least $20. However, this can vary depending on the clinic, plan and checkup type. The clinic can deduct the co-payment from the completion of any claim made for the visit.

4. Co-insurance:

Rather than a fixed amount, policyholders pay a predetermined percentage of the cost.

5. Out-of-pocket maximum:

In this scenario, once the policyholder has paid a certain sum of expenses within the span of a single membership year, a deductible or co-insurance prerequisite may be eliminated.

It highly depends on your situation, but you can moderate the cost of monthly premiums by opting for a higher deductible. For low-income earners, this is an economic choice with regards to regular insurance costs. The downside of this option, however, is the higher payments required to be made in emergency situations.

Your insurance is subject to annual limits, after which extra costs will emerge. However, lifetime limits exist too. By that, we mean once the insured part has reached a designated amount, they can no longer reap the benefits of the policy.

Factors impacting the cost:

1. Age:

Rates are directly correlated to age. Children up to the age of 14 will cost a flat rate to add to a health plan. However, premiums increase annually after the 15-year mark.

2. Location:

The state and county impact the insurance costs e.g. Jackson County residents will pay a higher rate for the same policy than residents of Miami-Dade County in Florida.

3. Tobacco Use:

California and New York don’t allow for this to influence the cost. However, if you smoke in certain states, you may have to pay 50% higher rates for the same health insurance plan.

4. Number of People insured:

The final bill is determined on the basis of the number of people covered by the scheme, their age and tobacco use.


Private medical clinics and health insurance policies premium costs have risen by 113 percent in the USA from 2001-2011. In response to this price escalation, 20 million policyholders resigned from their insurance policy between 2010 and 2011. After the Affordable Care Act, variables affecting health insurance costs have reduced.