There are many pros and cons to having private health insurance, with the most apparent benefit
being that health insurance helps cover the costs associate with healthcare (Protective 2022).
Things like doctors’ visits, ED visits, or specialty treatments can be covered in part or in whole by
having insurance. Larger bills such as hospital bills from surgical procedures or other types of
major treatments may also be covered at least in part depending on the plan. With health
insurance you can chose your own doctor and picking a doctor considered out of network may just
mean a higher cost compared to doctors in network. By enrolling in private health insurance
people can expect more choices compared to public plans, such as Medicare, this allows people to
more easily customize their health plan based on their needs. With private healthcare coverage
the experience may include shorter wait times, more one on one attention, and better facilities
where public facilities can be overcrowded and have lower quality care.
Additional pros include the ability for having health insurance to give people a sense of safety and
less worries when it comes to children (Andreas 2022). Better capabilities to plan a future and
those with health insurance have a life expectancy average higher than those without health
insurance. Regular medical checkups can help detect issues early on and lead to less
complications.
One of the biggest disadvantages however is the cost of private health insurance. This expense can
be especially difficult for those who suffer from poor health and do not have the access to a form
of group coverage and individual policies can cost hundreds a month and even more for families
(Protective 2022). There is also the likelihood that the policy will come with high deductibles and
copays that need to be paid before coverage kicks in. There is the issue of preexisting conditions
and the fact that some policies have diseases and conditions that they do not cover. If someone
has one of these diseases or conditions when it comes to paying for care and services, they will
need to cover it. The costs of healthcare continue to rise at a rate faster than the general inflation
rate with no signs of decelerating.
Cons can also be considered that even with insurance it can be expensive and not all insurance
companies may accept someone especially with pre-existing conditions or it may be even more
expensive for these individuals (Andreas 2022). Premiums can increase with age and some
insurance companies limit certain medical treatments. Having health insurance may tempt people
to go to the Doctor more often and people generally still must pay a fraction of the overall costs.
The benefits of having insurance are many. People with health coverage spend less out-of-pocket
for medical care. Their financial future is more secure due to decreased risk of catastrophic
medical payments (Tozzi, 2018). Persons with insurance are more likely to see the doctor more
frequently and get more preventative care and some studies have suggested that having insurance
reduces the likelihood of death (Kearney, et al., 2021). Despite the advantages of health insurance
“nearly 46% of insured adults report difficulty affording their out-of-pocket costs and one in four
(27%) report difficulty in affording their deductible” Kearney, et al. (2021). When you consider the
impact of vision, dental, and prescriptions the economic cost is even greater. 39% of adults have
put off dental care because of the cost and 25% say they have difficulty affording their
prescriptions (Kearney, et al., 2021). The decision to carry insurance or not most often comes
down to cost.
Prior to the adoption of the Affordable Care Act (ACA) there were circumstances where insurance
companies may deny coverage due to pre-existing conditions. That is no longer a significant reason
for failure to have health insurance. The ACA did not just expand coverage it also made significant
changes in the way that medical costs are shared. That has been favourable for some individuals
and families and others are now paying more. For those at or near the poverty line Medicaid is
provided at no cost, subsidies are provided for those up to a certain threshold (Currently about
$100K). Above the threshold, people pay the total cost. Because insurance companies are barred
from charging the sick more or refusing coverage, the cost for the healthy have increased to cover
the costs for all (Tozzi, 2018).
In the United States, many people do not think they need medical insurance because they do not
get sick often or do not go to the doctor yearly. Most insurers do not realize that it is cheaper to
pay out of pocket for some procedures than using insurance because it costs more through
insurance. The pros of not having insurance would be saving money on yearly deductibles getting
a procedure without approval from the insurance company. Another pro would be getting to
choose if a test is medically necessary. The cons of not having insurance will have to pay a high
hospital bill if the person becomes seriously ill. Also, consumers may die younger because they
cannot afford proper preventative care. According to Terri Williams, without health insurance
coverage, a severe accident or a health issue that results in emergency care and an expensive
treatment plan can result in poor credit or even bankruptcy (Williams,2021). Procedures, office
visits, imaging, emergency medicine, all of these are getting expensive over time because of the
number of innovations that have helped shape healthcare. The uninsured must understand that
healthcare costs will continue to increase, and they will need many sufficient funds to get the
proper care they desire. According to Jennifer Tolbert Kendal Orgera, when they are hospitalized,
uninsured people receive fewer diagnostic and therapeutic services and have higher mortality
rates than those with insurance. Research demonstrates that gaining health insurance
considerably improves access to health care and diminishes the adverse effects of having been
uninsured (Tolbert, Orgera,2020). The insured seem to have more options than the uninsured, but
that is if the insurance sees it necessary. For example, in the radiology place where I work at the
authorizations through insurance can be tricky because a lot of tests are denied because the
doctor did not provide enough information or the insurance do not see a reason why the patient
needs the trial, which can hinder the quality of care.
Many individuals who consider themselves to be in good health purposely avoid obtaining medical
insurance. In the first part of 2020, according to a report by the National Health Interview Survey
(NHIS), 9.7% or 31.6 million adults lacked health insurance. Survey findings showed that the
uninsured rate and number of uninsured decreased from 2019 (10.3% or 33.2 million people of all
ages), but the difference was insignificant (Williams, 2021).
There are many cons to choosing to refrain from purchasing medical insurance. The National
Center for Chronic Disease Prevention and Health Promotion reports that six in 10 Americans have
been diagnosed with a chronic health condition, such as high blood pressure, high cholesterol, or
being overweight or obese. A study completed by the Transamerica Institute revealed that 66% of
the uninsured suffered from a chronic illness. Ninety percent of America’s $3.8 trillion in annual
healthcare expenditures stem from citizens coping with chronic diseases and mental health issues
(Williams, 2021). Most preventive care is covered by insurance policies and is a critical component
of identifying illness or worrisome health conditions early, before they develop into full-blown
critical problems. Catching health problems early increases the probability of successful treatment
and reduces overall healthcare costs for treatment. Many individuals without medical insurance do
not engage in preventive care (i.e., annual primary physician physicals, bloodwork, OBGYN annual
check-ups, etc.), resulting in an increase of more serious illnesses that could have been caught
much sooner. It has been documented that those with medical insurance have higher life
expectancies. Additionally, without medical insurance, a serious accident or health issue resulting
in emergency care can leave a patient with a bill so high that it pushes them into bankruptcy. For
several years, medical debt has been the number one cause of personal bankruptcy. According to
a recent study in the Journal of the American Medical Association, 17.8% of individuals had
medical debt in collections in June of 2020 (Williams, 2021).
Although I believe that the cons of not having medical insurance outweigh the benefits, it is
important to understand why people choose to not pay for healthcare coverage, especially if they
are younger and/or in good health. Medical insurance can be very costly, sometimes absorbing a
large fraction of a person’s monthly income. People who already work low-income jobs and need
every dollar to support their families cannot fathom the thought of paying such a high expense
every month for medical coverage “just in case” something happens. Additionally, some health
insurance companies may not accept individuals if they have certain pre-existing conditions since
they feel that they are at greater risk of suffering from serious health conditions in the future. For
people that fall into this category, it can be very difficult and time-consuming to find an insurance
company that will accept them. When they do find an insurance company willing to bring them on
board, the cost can become even more unaffordable because the customer has a pre-existing
condition. Furthermore, insurance companies can exclude important and costly medical treatment,
premiums may increase as you get older, and you may still end up having to pay a fraction of the
overall costs (O’Rourke, 2021). In conclusion, there are many strong reasons why an individual
should purchase medical insurance. However, some individuals cannot afford the high cost, denial
of coverage for certain treatments and/or pre-existing conditions, and the residual costs that
remain even after medical insurance is applied. Medical insurance must be more affordable and
accessible so people are enticed to enrol in it; otherwise, the likely outcome is even higher costs
associated with advanced stage illness that could have been prevented if medical treatment was
sought sooner.
There are several obvious pros and cons to not paying for health insurance when you are young
and healthy. The first pro is not having to pay the cost for insurance benefits that you may or may
not use; the costs of medical, eye, and dental insurance all vary depending on the place that you
work and the size of the company- if you are employed- which means that the cost of insurance
may be astronomical. If you make “too much” then there is not an option to get more affordable
coverage through government programs such as Medicaid; this means that you are left spending a
large amount of your pay check on insurance coverage that you may not even use. When you do
not have health insurance, you are less likely to utilize services and ultimately are more likely to
spend less on out-of-pocket services (Institute of Medicine, 2003). There was a tax penalty under
the Affordable Care Act, but Trump repealed that act so individuals do not have to worry about a
federal penalty for not having insurance (Williams, 2021). However, certain states have penalties
for not being insured so individuals need to be aware of their state legislation.
The obvious con of not having medical insurance is that if some accidents were to occur and you
needed medical care you would have to pay out of pocket because you would have no insurance
coverage. Hypothetically, if the accident were extensive and you ended up in the ICU in coma for
weeks or months and you finally managed to come out of it, then you would eventually find
yourself with a bill you cannot pay. Not only would you have to deal with hospital collections on
top of not being paid for the time you were out of work, but you would likely go broke trying to
pay your medical bills. If the situation progressed to the point where you could not pay your bills,
then the less noticeable con of not having insurance comes into play- insurance companies and
healthcare facilities or practitioners must absorb those costs. This means that costs of tests,
procedures, and treatments may increase, and insurance costs for everyone who does have
coverage increases to cover the costs of those who are uninsured and/or do not pay (Institute of
Medicine, 2003). Another con is that if one is seeking private or specialty care, the practitioners
can refuse the patient for not having insurance. Something that likely is not on the forefront of
the minds of those who are young and healthy, is the fact that by not having medical insurance
and going for regular checkups i.e., dental cleanings, yearly physicals, these individuals are missing
out on preventative services that could ultimately help them live longer, healthier lives.
I believe a lot of the reasoning behind not getting health insurance is the cost, especially when a
person does not have a good paying job, or a job that offers insurance that is partially covered by
the employer. b The national cost for health insurance in 2020 was $456 per person, and $1152 per
family. (Porretta, 2022) I can vouch for this because as a small business employee, and my
husband as a self-employed person, we have had to pay a very high premium for our insurance. It
has never been less than $1200 a month for us, a family of 4. Even looking at the market place, it
was about the same, and sometimes even higher. This is very challenging when you add a
mortgage, taxes, utilities, car payments, and worse of all, childcare expenses.
So, what are the pros of not having health insurance if you are healthy?
I believe the only benefit to this is the ability to temporarily save some money from not paying an
insurance cost. Of course, this would go out the window instantly if something medically should go
wrong on an uninsured person.
What are the cons of not having health insurance?
There are far more cons for not having health insurance than having it. Some of the cons of not
having insurance may be the cost of healthcare in general, difficulty paying for medical
treatments, not seeking regular preventative care, and unable to afford needed medications.
(Porretta, 2022)
I would say that people who do not have health insurance skip out of preventative care, periodic
exams, and most medications they may need, depending on the cost. I see this a lot with dental
care. A lot of people skip out coming to the dentist if they have no dental insurance, because they
cannot pay or refuse to pay for the preventative care. Unfortunately, these are also the people
who come in the office when "something hurts", which at that point, the care becomes even more
expensive. b Many of these expenses could be prevented if the patient has had routine care.
Porretta, A. (January 21, 2022). eHealth. "How Much Does Individual Health Insurance Cost?"
Retrieved from https://www.ehealthinsurance.com/resources/individual-and-family/how-much-
does-individual-health-insurance-cost
Porretta, A. (January 21, 2022). eHealth. "Is It Ok To Be Uninsured?" Retrieved from
https://www.ehealthinsurance.com/resources/individual-and-family/is-it-ok-to-be-uninsured
Institute of Medicine (US) Committee on the Consequences of Uninsurance. (2003). Hidden costs,
values lost: Uninsurance in America. National Academies Press.
Williams, T. (2021, September 27). Do not have Health Insurance? what's The worst that could
happen? Investopedia. Retrieved January 31, 2022, from
https://www.investopedia.com/articles/personal-finance/120815/dont-have-health-insurance-
whats-worst-could-happen.asp
O’Rourke, P. (2021). 25 Important Pros & Cons of Health Insurance. Retrieved from
https://environmental-conscience.com/health-insurance-pros-cons/.
Williams, T. (2021). Don’t Have Health Insurance? What is the Worst That Could Happen?
Retrieved from https://www.investopedia.com/articles/personal-finance/120815/dont-have-health-
insurance-whats-worst-could-happen.asp.
Orgera, K. F. @_K. O. on T., & Tolbert, J. (2020, November 12). Key facts about the uninsured
population. KFF. Retrieved February 4, 2022, from https://www.kff.org/uninsured/issue-brief/key-
facts-about-the-uninsured-
population/#:~:text=When%20they%20are%20hospitalized%2C%20uninsured,rates%20than%20tho
se%20with%20insurance.&text=Research%20demonstrates%20that%20gaining%20health,effects%2
0of%20having%20been%20uninsured.
Williams, T. (2021, September 27). Don't Have Health Insurance? What's The worst that could
happen? Investopedia. Retrieved February 3, 2022, from
https://www.investopedia.com/articles/personal-finance/120815/dont-have-health-insurance-
whats-worst-could-happen.asp
Kearney, A. (2021, December). Americans' challenge with health care costs. KFF. Retrieved January
31, 2022, from https://www.kff.org/
Tozzi, J. (2018). Why some Americans risk it and are skipping health insurance. Bloomberg.com.
Retrieved January 31, 2022, from https://www.bloomberg.com/
Andreas. (2022). Advantages & Disadvantages of Health Insurance. Global Awareness UG.
Retrieved from: https://environmental-conscience.com/health-insurance-pros-cons/
Protective. (Retrieved Jan 31, 2022). Facts about the advantages and disadvantages of health
insurance. Protective. Retrieved from: https://www.protective.com/learn/advantages-and-
disadvantages-of-health-insurance
