Background: Patient Satisfaction is perception towards services they get from health institution. Even if different strategies were drafted to increase patient satisfaction with primary health care service, it is still a great challenge from public health centers including Gonggi Kollela woreda in West Gojjam where this study was conducted. Therefore, the study was aimed to assess patient satisfaction level and associated factors among insured and non-insured patients. Methods: Comparative cross sectional study was conducted from June through July 2022. Data were collected through Face-to-face interview from 314 Insured and 376 Non-insured out patient service users by trained health professionals. Epidata and SPSS were used for data entry and analysis respectively. Simple frequency tables were used to summarize descriptive statistics. Binary logistic regression analysis was used as method of analysis and to evaluate statistically significant relationship between dependent and independent variables. Hosmer and Lemshow Test assumptions had been checked for diagnosing goodness of model to given data set. Results: The overall satisfaction of participants was 59% and satisfaction of insured and non-insured patients was 66.2% and 52.9% respectively. This difference in satisfaction level between insured and non-insured participants was statistically significant with (AOR= 1.745, at 95% CI= [1.281, 2.378] and p-value= 0.001). Insured patients were 1.745 times more likely to be satisfied with primary health care services as compared with non-insured. The satisfaction level of study participants was associated with safety of waiting area, diagnostic examinations conducted by care providers, availability of laboratory investigations and drug in facility, getting of service according to turn, construction and sanitation of health facility. The study had also found factors that were associated with satisfaction of insured and non-insured patients. Conclusions and Recommendations: The study had found that insured patients had better satisfaction than non-insured patients with primary health care service. Therefore, to improve patient satisfaction level with primary health care services providers should provide service according to their turn, conduct proper examination, protect patient confidentiality and ask their patients about any treatment taken before coming. Woreda health office, zonal and regional health offices and Program managers also should act on associated factors identified by the study and should conduct further research to find out additional points. Keyword: CBHI, Satisfaction, OPD, PHCS, Gonggi Kollela