Private health insurance is the greatest source of health insurance coverage for people under age 65. Medicare, discussed in the next section, provides public or social insurance for the majority of people who are age 65 and older, as well as for people with certain types of disabilities, including end-stage renal disease (ESRD). In 2003, 68.9 percent of the population under the age of 65 reported some form of private health insurance coverage (U.S. Department of Health and Human Services [USDHHS] 2005). Figure 3.3 shows the percentage of the population with private health insurance by age, gender, race/ethnicity, and various poverty levels. Children under age 18 below the federal poverty level had the lowest insurance coverage rates of any of these demographic groups.
Two types of private health insurance are available in the United States: individually purchased policies, which are usually limited in coverage and relatively expensive to purchase, and insurance provided as one of the benefits of employment. Employer-sponsored insurance is generally more comprehensive in scope because the risk of insuring is spread over a group of employees and because those in the workforce are generally healthier than those of working age who are not in the workforce and are not the dependents of an insured worker. Group insurance is thus less expensive per person than individual policies. In most cases, employers and employees share the cost of this insurance. Many employers are beginning to shift a greater proportion of these costs to their employees.
Individual policies are purchased by people who can afford them, who may be self-employed, who work in industries such as mining or fishing in which insurance is difficult to obtain, or who otherwise do not have access to a group health insurance policy. Individual high-deductible policies may also be purchased by people who do not anticipate much utilization of health services but want the security of catastrophic coverage. Individual policies often impose stringent limitations for preexisting conditions.
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