Tips for buying individual health insurance

There is strength in the numbers, particularly when you are buying health insurance. As part of a group work plan, you can generally enjoy lower rates – but sometimes you may not have the option of joining a group plan.

There is strength in the numbers, particularly when you are buying health insurance. As part of a group work plan, you can generally enjoy lower rates – but sometimes you may not have the option of joining a group plan.

An individual plan is one that is purchased in the private market, not associated with employment benefits. Although they are called “individual” plans, they can cover you, your spouse, and your children.

There is no guarantee that an insurer will accept you on an individual policy. Individual plans are medically provided and the insurer may reject your application or add exclusions to your policy if you have health problems. Under “guaranteed issue” laws, some states do not allow this practice and require insurers to offer you a policy, regardless of medical problems you may have. The Kaiser Foundation has a list of guaranteed emission laws.

People enrolled in individual plans pay premiums determined primarily by estimated health care costs, so prices may be higher for those who are elderly and / or less healthy.

Calculating expenses

Pricing is probably the most baffling aspect of individual insurance policies, so health insurance rates are worth quoting. For example, premiums for similar products from different insurers can vary up to 50 percent for the same person.

If you’re faced with finding individual health insurance, don’t let confusion tempt you into thinking you don’t need it. Even if you are in good health, you could fall off a ladder or have a serious car accident and this could force you to declare “medical bankruptcy.”

In addition, you will lose your rights to coverage of pre-existing conditions if you remain uninsured for 63 days or more, a period of time established by the Health Insurance Accounting and Portability Act (HIPAA).

How to choose an individual health insurance plan

When looking for an individual health insurance policy, it is in your best interest to do your homework. According to Cheryl Leamon, the spokesperson for the insurer Blue Cross Blue Shield Anthem, you should ask yourself the following key questions:

Do I want to stay with my current doctor? If you have a primary doctor you prefer, that could dictate whether an HMO or PPO plan suits you. In an HMO plan, you must use a doctor in the plan’s network in order to receive coverage. A PPO plan allows you to visit any doctor.
What is my family’s current and anticipated health care need? Consider the services that you and your family will need regularly. If your child has asthma, will he have to visit an asthma specialist routinely to keep it under control?

What will my out-of-pocket costs and monthly premiums be? Does it make sense to pay a high premium to spend less out of pocket? If you want a comprehensive health plan – and don’t want a lot of out-of-pocket costs – an HMO plan provides an effective option. But if you’re in your 20s or 30s, don’t have kids, and have some extra savings, you could save by buying a policy that only covers catastrophic illnesses. Remember, you will have to pay out of pocket when you go to routine visits with your doctor and when obtaining laboratory tests.

Does the plan cover prescriptions and x-rays? Prescriptions are one of the most widely used benefits of medical plans. Examines the coverage of any health plan to determine if and to what level they cover your current prescriptions. X-rays are a routine part of some treatments, so it’s wise to find out if x-rays are covered in every plan you consider.

Do I prefer certain specialists? Some plans limit not only your visits but also who you can visit. If you want to see an acupuncturist or chiropractor, be sure to ask your insurance agent about coverage for these services. Psychotherapy and other mental health services will likely have specific limitations as well.
What should I do if I can’t afford a policy that covers routine care? Look for plans that are complete with higher deductibles instead of cutting your coverage. A basic hospital / surgery plan may cost less, but if you end up in the hospital, the last thing you want to add to your list of concerns is to think about how you will pay for the necessary follow-up care when you are discharged.

How much will it cost me to get emergency care? Review costs, including copays or coinsurance, or hospital and surgical care services, that apply to the deductible. Leamon advises examining what your policy defines as “emergency care”.

“Some policies pay for a broken leg or injury due to an accident, but they will not cover an illness you were treated for in the emergency room. Other cheaper plans will cover an emergency room visit, but not a stay. prolonged in the hospital. Since emergency care can be the most expensive in any medical plan, it is best to read the fine print of any contract, “says Leamon.

Individual coverage at the price of collective coverage

In some states, if you are self-employed, you may be eligible to purchase “group of one” health insurance – even if you work at home – if you can show that you have owned your business for a minimum of 30 days. The Kaiser Family Foundation has a list of states where you can buy “group one” health plans by “guaranteed issue.”

Even if you live in a state that does not offer “group of one” insurance policies, you may still be able to qualify for a group rate if you are a business owner and have at least one partner or employee. Does your wife help in accounting for your company? Then you have a two-person business, eligible for the group rate and a group policy.

If you are leaving an employer where you had a group health plan, you can ask your insurer to convert coverage to an individual insurance plan. The rate will be higher than the group plan, but it is a way to ensure health insurance if you have a medical history. Or, if your spouse has a group plan at work, he or she can add you.

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