Finding An Insurance Plan To Meet Your Needs
Health insurance companies usually offer individual insurance policies but depending on your age and health, there can be problems
. If you have a serious medical condition or are over 50 years old but not old enough for Medicare, you may not be able to find coverage. Many health insurance companies require a medical exam before allowing coverage to make sure there are no serious health problems. Other issues in getting individual health coverage can include higher cost and fewer benefits than group coverage.The first step in finding individual health coverage is to determine how much you can afford to pay in monthly premiums. Once you know how much you can spend you can begin to compare plans that best meet your needs at that price.
There are some important questions to ask when comparing the cost and benefits of the health plans you are researching.
What is the monthly premium and does it fit into my budget?
How much does the insurance pay for doctor and hospital bills?
What services are covered? Do the benefits include emergency or urgent care visits, surgery and hospital stays? What about nursing home stays, home health care and medical equipment?
Is there a deductible and how much do I pay for office visits?
Is preventive care included, such as routine checkups and immunizations?
Is there a pre-existing clause that will prevent me from getting the care I need? If there is a clause, how long does it last?
Is there dental, vision or prescription drug coverage?
Is there catastrophic coverage? Is there an out of pocket maximum or limit to how much I pay each year?
Is there a yearly or lifetime benefit maximum that will be paid by the insurance plan?
There are five different options to consider when purchasing individual health insurance- fee for service, managed care and open enrollment managed care, association based plans and high risk pools.
A traditional type of health insurance is fee for service or indemnity plan. With this type of plan, the insurance company pays a part of each medical service whether it's a doctor visit or hospital stay. The rest of the cost of care is paid by you. A benefit of this plan is that you can see any doctor you choose and utilize any hospital you choose however, this freedom of choice usually comes with a higher monthly premium than a managed care plan. Also, this type of plan is not as common as it used to be.
Managed care plans are very popular and many people utilize these for their health care. There are two types of plans; health maintenance organization (HMO) and preferred provider organization (PPO).Managed care plans contract with doctors and hospitals who then agree to provide health care to the plan members. These doctors and hospitals are then part of the plan network. You can only see the providers within this network in order for your health care to be covered. Some PPO plans allow you to utilize out of plan providers but you will pay more in out of pocket costs. A benefit of these managed care networks is that you would only pay a small co-payment amount each time you see your doctor. These co-payment amounts are usually between $10 and $20.
There are some states that require managed care plans to have a yearly "open enrollment" period. During this time, usually a one month period, the managed care plans are required to allow people to join the plan even if they have a serious medical condition. There are no medical exams required so you don't have to prove you are insurable. This is helpful if you've been turned down for coverage due to a medical condition.
You can also check your state insurance department to see of this option applies to more health insurance plans than just managed care. Some states require all health insurance companies to offer their plans to people who cannot get health insurance due to medical conditions.
Health insurance is often available through professional or trade organizations. There are also community and religious organizations that may also offer health insurance to their members at group rates. If you are a member of any organization, find out if they offer health insurance coverage. You should ask the same questions that were previously listed and you can also contact your state insurance department to find out your rights regarding this type of health insurance coverage.
The final type of health coverage is enrolling in high-risk pools. Some states offer health insurance to people who cannot get health coverage due to a medical condition. This type of coverage is a last resort if all other attempts to get health coverage have failed. In order to qualify for a high risk pool, you must have been denied health coverage by one or two insurance companies. Another way to qualify is if you cannot find a plan with a lower monthly premium than the premium offered by the high risk pool.
The new federal health care law has established insurance programs for those with pre-existing conditions. These programs have changed some of the qualifying rules. For full descriptions of these plans and their enrollment rules go to www.healthcare.gov or www.pcip.gov.
If determining which health plan is best for you is still too difficult, then you can talk to a health insurance broker. There are independent brokers who sell different kinds of health insurance and there are brokers who sell plans from only one company. You should talk to a few brokers to be sure you are choosing the right one. You must also determine how the broker is paid. Some brokers are paid by you and others are paid a commission by the health insurance company. The payment process may affect the plan recommended by the broker so make sure the broker works in your best interest. The downside to using a broker is that it may cost more and there may be a limit to the availability of some health insurance plans.
There are other types of insurance policies such as "cancer policies" or hospital indemnity policies. These should not be mistaken for comprehensive health coverage. These policies only pay for a specific disease or may set a monetary amount that you receive each day you are hospitalized. Some of these policies sound good but won't actually help with your health care costs.
Finding a good individual health insurance policy takes commitment and a lot of work. The benefit of this research is finding a policy that fits your budget and your current needs.
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