Health Care is not the same as Health Insurance

In the discussion about the Patient Protection Act it seems that there is some misunderstanding between what Health Insurance and Health Care actually is.


Health Insurance:

Health Insurance is “insurance” against the risk of incurring medical expenses among individuals.  Health Insurance companies estimate the risk of health care expenses among a target group; they then establish the monthly premium it will take to insure that group.

Health Insurance Premiums are the monthly bill that members pay to receive services based upon the contract with the Health Insurance Company.  Other expenses for members include deductibles and co-pays for services received.

Health Insurance companies then help members pay for the health care they receive out of the premiums the member paid to the health insurance company.

Health Care:

Health Care is the actual diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments.  Health Care providers include hospitals, doctors, pharmacists, nurses, etc.  Health care is what you actually get when you go to the doctor and they do something to treat your condition.  It also includes the in-home nursing care.  It is not health insurance.

Single Payer Health Care:

Single Payer Health Care is medical care funded from a single insurance pool run by the state.  Single payer health insurance collects all medical fees, then pays for all services through a single government or government related source.  One example of Single Payer Health Care system is Medicare.

Public Health Insurance Option

The public health insurance option was to have health insurance offered by the federal government.  It would have made cheaper health insurance available for those that could not afford high rates of private insurance, didn’t have health insurance offered at work, or those that were rejected for coverage by private insurance companies.  It would have allowed the government to negotiate for lower costs for services, much the same as they do with Medicare and Medicaid.  It would have been funded by the premiums collected.  It was removed from the Affordable Health Care Act.

What is Medicare and how does it work?

Medicare coverage is a Federal Health Insurance program for Americans age 65 and older, some disabled Americans, individuals who have end-stage renal disease, and those that qualify.

Medicare has four parts:

  1. Part A Hospital Insurance
  2. Part B Medical Insurance
  3. Part C: Allows the recipient the choice of receiving benefits of parts A, B, and D through private health plan like HMO or PPO; otherwise known as Medicare Advantage.  Medicare pays a fixed amount for your care every month to companies offering Medicare Advantage Plans.  The companies have to follow the rules set by Medicare.  However, each plan can charge different out of pocket costs and have different rules for how you get services.
  4. Part D: Provides payments for doctors and related services, and prescription drug coverage.  This is run by Medicare-approved private insurance companies.

Medicare has monthly premiums based on income, and a low deductible.  Low income seniors can also qualify for Medicaid to help pay for costs.

What is Medicaid?

Medicaid is a joint Federal and State program that helps pay medical costs people with limited incomes and resources. The program varies from state to state.  This includes the Children’s Health Insurance Program that provides coverage to more than 31 million children.

Medicaid also finances:

  • Pregnant Women: Medicaid specifically pays for 40% of all births in the US.  The program pays for prenatal care, labor and delivery, and for 60 days postpartum as well as other pregnancy related care.
  • Children: more than 31 million including half of all low income children.
  • Non-Disabled adults:  11 million non-elderly low income parents, caretaker relatives, pregnant women, and other non-disabled adults.
  • Individuals with disabilities: over 8.8 million non-elderly individuals with disabilities are covered.
  • Seniors and Medicare and Medicaid Enrollees: over 4.6 million low income seniors; including 3.7 million people with disabilities who are also enrolled in Medicare.

[viii] Medicare Costs 2012 (

[ix] What is Medicaid and who does it cover? (


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