Private insurance refers to health insurance plans that are offered by private companies rather than government-run programs. These plans are typically purchased by individuals, families, or employers to cover health care costs. Private insurance operates in a competitive marketplace, offering a variety of plan options tailored to different needs and budgets. It can be purchased through the health insurance marketplace, direct from a health insurance company or broker, or through your employer.

Health Insurance Marketplace®

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The Health Insurance Marketplace® (healthcare.gov) is a platform established by the Affordable Care Act (ACA) where individuals and families who are uninsured can shop for and purchase comprehensive ACA-qualified health insurance plans.

• Overview
• Appeals and Denials

Employer-sponsored health coverage

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Employer-based health care is a type of health insurance coverage provided through an employer. It is one of the most common ways people in the United States access health insurance. Employers often offer health insurance as part of an employee benefits package, which may also include other benefits like dental, vision, and retirement plans.

There are two main types of employer health insurance: fully insured plans and self-insured (or self-funded) plans.

• Overview
• Appeals and Denials

Public health plans are government-funded or government-regulated health insurance programs designed to provide health care coverage to specific populations, such as pregnant women, older adults, children, people with disabilities and low-income families. Public health plans available in the United States are described below.

Medicaid

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Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.

• Overview
• Appeals and Denials

Medicare

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Medicare is a federal health insurance program that is divided into four parts – each covering different services. Medicare is primarily for people 65 years old and older, a person under the age of 65 may qualify for Medicare coverage if they are receiving Social Security disability benefits or if they have been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

• Overview
• Appeals and Denials
• Using Your Medicare Card

TRICARE®

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TRICARE® is the primary health insurance program for active-duty service members, veterans, and their families. It is run by the U.S. Department of Defense and is designed to ensure that those who serve or have served in the military, along with their dependents, have access to comprehensive health care services.

• Overview
• Appeals and Denials

Veterans Health Administration

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Veterans health care refers to medical and health-related services provided by the U.S. Department of Veterans Affairs (VA) to eligible military veterans. This system, managed by the Veterans Health Administration (VHA), is one of the largest integrated health care systems in the United States. It is specifically designed to meet the unique needs of those who have served in the military.

• Overview
• Appeals and Denials

Indian Health Services (IHS)

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The Indian Health Service (IHS) is a government program that provides health care to American Indians and Alaska Natives. It is part of the U.S. Department of Health and Human Services and helps people get medical care for free or at a low cost.

• Overview