Individual Health Insurance Buying Tips
Individual health plans are purchased on the private market and are not associated with any workplace benefits.
These plans are called "individual," but they include coverage for a spouse and children.
These types of plans are medically underwritten so your application may be rejected or your policy could include exclusions if you have health issues.
Some states do not allow this and require health insurers to offer policies regardless of any health issues.
These are called "guaranteed issue" laws.
People who are older or less healthy can expect to pay higher premiums.
Individual plan premiums are based on expected health care costs.
Policy pricing can be very confusing so it's best to shop around.
Premiums can vary between insurers, sometimes up to 50 percent for the same person.
Confusion about policies and premiums may make you want to go without coverage but don't let that happen.
Even healthy people have accidents and if you are without coverage for more than 63 days, you lose pre-existing coverage rights.
This time period was set up by the Health Insurance Portability and Accountability Act (HIPPA).
The new health care law will eliminate lowering coverage for pre-existing conditions but that provision won't take effect until 2014.
Research is the key when shopping for an individual health insurance policy.
There are seven key questions you should ask yourself before purchasing a policy.
Some states allow you to buy health insurance as a "group of one.
" If you are self-employed, the sole proprietor, and can show that you have been in business for at least 30 days, you can purchase as a group.
You can still qualify for a group rate even if you do not live in a state that offers "group of one" policies.
If you own your business and have at least one partner or employee, you are eligible for a group rate and group policy.
If your spouse helps you than that is considered a two-person business and you will still qualify.
There two options for coverage are for if you are leaving an employer and you had group coverage through your workplace.
First, you can request that the insurer covert your coverage to an individual plan.
The premium will be higher than the group plan but there would be continuity in coverage and security if you have health issues.
Second, you can be added to a spouse's policy if they have group coverage through a workplace.
These plans are called "individual," but they include coverage for a spouse and children.
These types of plans are medically underwritten so your application may be rejected or your policy could include exclusions if you have health issues.
Some states do not allow this and require health insurers to offer policies regardless of any health issues.
These are called "guaranteed issue" laws.
People who are older or less healthy can expect to pay higher premiums.
Individual plan premiums are based on expected health care costs.
Policy pricing can be very confusing so it's best to shop around.
Premiums can vary between insurers, sometimes up to 50 percent for the same person.
Confusion about policies and premiums may make you want to go without coverage but don't let that happen.
Even healthy people have accidents and if you are without coverage for more than 63 days, you lose pre-existing coverage rights.
This time period was set up by the Health Insurance Portability and Accountability Act (HIPPA).
The new health care law will eliminate lowering coverage for pre-existing conditions but that provision won't take effect until 2014.
Research is the key when shopping for an individual health insurance policy.
There are seven key questions you should ask yourself before purchasing a policy.
- Do I want to keep my current physician? Wanting to see a particular physician will determine what kind of plan may be best for you, either an HMO or a PPO.
With an HMO plan you need to see their network of doctors but a PPO plan will allow you to see any doctor. - What are the current and anticipated health care needs of the household?You need to consider what services will be needed on a regular basis.
Will you only need routine services or is there a health issue to consider? - What will be my out-of-pocket costs compared to my monthly premium costs? Determine which makes more sense for your situation.
Paying a higher premium or higher out-of-pocket costs.
If you don't want to pay a lot out-of-pocket then an HMO would be best.
If you are young, healthy and have savings, then catastrophic coverage may work. - Are X-rays and prescriptions covered under the plan? The most use plan benefits are for prescriptions.
Make sure any current medications will be covered.
X-rays are often part of many treatments so make sure they are covered by the plan. - What specialists will I utilize? If you plan to see a chiropractor, make sure this type of treatment is covered.
Also, remember that mental health services often have specific limitations.
Make sure you know and understand what the plan limitations are. - What do I do if I can't afford a policy that covers routine care? Comprehensive plans that have higher deductibles should be considered.
Instead of cutting coverage you may need to pay a little more out-of-pocket.
A basic policy may cost less initially but could cost substantially more if you are injured. - What is my cost regarding emergency care? Find out what the policy considers to be "emergency care.
" This can vary among insurers.
Look at what the co-pays or co-insurance is and if any of it applies to your deductible.
Always read the fine print.
Some states allow you to buy health insurance as a "group of one.
" If you are self-employed, the sole proprietor, and can show that you have been in business for at least 30 days, you can purchase as a group.
You can still qualify for a group rate even if you do not live in a state that offers "group of one" policies.
If you own your business and have at least one partner or employee, you are eligible for a group rate and group policy.
If your spouse helps you than that is considered a two-person business and you will still qualify.
There two options for coverage are for if you are leaving an employer and you had group coverage through your workplace.
First, you can request that the insurer covert your coverage to an individual plan.
The premium will be higher than the group plan but there would be continuity in coverage and security if you have health issues.
Second, you can be added to a spouse's policy if they have group coverage through a workplace.
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