Individual Health Insurance Buying Tips

Buying into group health coverage is almost always the best way to enjoy a lower rate on individual health insurance premiums.

Sadly, a group option may not be available. For instance, say you leave your current job or start a job where health insurance isn’t offered. In such cases, you’re probably going to be a little taken aback by the price of individual health insurance.

We hope the following tips will help you make a better, more informed decision when shopping for individual health insurance.

How Does Individual Health Work?
Individual health insurance is the same kind of insurance you get from an employer except that you purchase it yourself.

Despite being called “individual” plans, you can also cover your spouse and children as well.

You should always remember that coverage is not guaranteed. Individual health insurance policies are approved on a person-by-person basis so if you have a preexisting condition or chronic health condition, you may be rejected or the insurance underwriter may attach exclusions.

Some states have “guaranteed issues” laws under which this practice is illegal. In such cases, the health insurer must offer you a policy no matter the medical issues you may have. You can find a list of states with guaranteed issues laws here.

In other instances, persons covered under individual health insurance plans may have to pay premiums based upon their projected healthcare expenses, so prices might be a higher for older and/or less healthy subscribers.

Finding the Right Individual Health Insurance Plan
There are a couple of things you need to think about before you choose an individual health insurance plan.

• Doctor
  Will the plan allow you retain your current primary physician? Such a consideration will likely be deciding factor between whether you go with an HMO or PPO. An HMO means you have to choose from a doctor in their network, whereas a PPO lets you see whomever you want.


• Healthcare Needs
  Figure out how much individual health insurance coverage you anticipate needing. Will you and/or your family need medical services occasionally or regularly? Will you need to see a specialist if you have a family member with a chronic condition like diabetes or asthma? Such factors will greatly impact a policy’s cost.


• Costs
  Next, consider cost factors such as out-of-pocket expenses and monthly premiums. Figure out if it makes financial sense to pay more in premiums in exchange for a lower out-of-pocket. Typically, the best way to approach this is to figure out whether you want comprehensive coverage for you and your family. If so, an HMO is probably the best way to go.
  
  However, if you are younger, in sound health, and don’t have children, then you’re probably best off taking a lower premium plan that just covers catastrophic medical expenses. This will protect you from the possibility of financial ruin should the unthinkable happen. In exchange, you will have to pay a specified out-of-pocket deductible. It won’t be cheap, but it will pale in comparison to what you might have to pay if you aren’t protected at all.
  
  Those who elect to go the latter route are best having a contingency healthcare fund saved. Plans such as this can often be paired with a special tax-free Healthcare Savings Fund (HSF) for maximum effect.


• Prescription Drugs and X-Rays
  Figure out then if the plan covers x-rays and prescription drug costs. Prescriptions in particular are usually the most oft-used component of an individual health insurance policy. If you are currently on prescription drugs and this is important to you, pay special attention to what a plan offers.
  
  This goes as well for x-rays. Often x-rays are an integral part of routine procedures, however some plans may not cover them.


• Specialists
  Consider whether a plan covers specialists. If you’re accustomed to seeing a mental health specialist or chiropractor, be sure to ask whether an individual health insurance plan covers these kinds of services. Often, there may be special limitations you should know about.


• Routine Care
  While it might seem like a good idea to have a basic, inexpensive hospital/surgical plan, consider that even if you do end up in the hospital, it’s likely you will encounter further treatments and follow-up care upon release. It’s always a good idea to carefully consider a comprehensive plan with a higher deductible.


• Emergency Care
  Carefully examine how a plan defines emergency care and costs such as co-insurance and co-payments. Understand also, what services a plan does and doesn’t cover and whether they work towards your deductible.

Group of One Health Insurance
There are a couple of states that allow “group of one” policies. In essence, these allow you to buy group coverage even if you are the sole proprietor or a home-based business. Typically all you need to do is prove you’ve been operating as a business for at least a month.

For those who don’t live in a group-of-one state, you may be able to qualify for a group policy rate if you have at least one employee or a business partner.

Finally, if you are planning on leaving your current employer, make sure you speak with your insurer about the possibility of converting your group plan to an individual health insurance plan. Alternatively, if your spouse is on a group policy with their employer, see if it is possible for them to add you to it.

Once you’re ready to make a decision, IndividualHealthInsurance.org is here to help. Just fill out a quick 100% risk-free form and take full advantage of a professional insurance agent’s advice.