Understanding Individual Health Insurance
What is Individual Health Insurance?
Health insurance covers medical expenses for illnesses, injuries and conditions and helps you manage healthcare costs for you and your family. But, unlike a plan through an employer, individual health insurance is something you select and pay for on your own. Though the name suggests otherwise, an individual can buy health insurance for themselves or for entire family.
Why do I need Individual Health Insurance Policy?
There are several reasons why one may opt for individual health insurance policy:
- Flexibility: Individuals choose a policy that best fits their needs, including type of coverages, percentage of coverage, providers and policy terms
- Coverage: Individual health insurance covers all essential health benefits, and is available to everyone regardless of pre-existing medical conditions
- Portability: Employees may keep their policy when they switch jobs
- Savings: Employees may be eligible for a premium tax credit on purchase of individual health insurance. Also, many preventive care services (like annual checkups) may be covered.
How do I Select and Buy an Individual Health Insurance Policy?
Policies can be purchased through a licensed health insurance agent or through the Health Insurance Marketplace. When you’re looking at health insurance plans, the biggest differences are in the services they cover and how much they’ll pay for those services. Here are some of the factors to keep in mind:
- Coinsurance and deductible: No matter which plan you choose, you’ll pay a monthly payment, known as ‘premium’, to keep your health insurance coverage. However, with some plans, you’ll pay a certain amount when you have a service. This amount is called a co-payment or coinsurance. You might also be needed to pay a ‘deductible’, which is the amount you’ll have to pay for covered services before the insurance starts paying. Generally, the more you pay per month (premium), the lower your deductibles.
- Limit: It’s important to know the limits of a plan before you choose. For example, elective, cosmetic or alternative therapies are common treatments that are not generally covered by health plans as many are not considered medically necessary.
- Network type (HMO, PPO, POS, and EPO): Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.
- Flexibility of selecting a doctor: With some plans, you’ll choose a doctor to work with and help manage your care. That’s called a Primary Care Physician (PCP). If you need to see a specialist, you’ll often need a referral from your PCP. With other plans, you can go directly to a provider in your network (PPO) to make appointments. Decide if you prefer to work with the advice of a PCP or manage specialists on your own.
- Prescription drug coverage: Each plan has a list of medications that are covered. This is called the Prescription Drug List. If you have medications you take on a regular basis, check the list so you’ll know your costs and possible deductibles before you choose your plan.
What is Covered and What is not?
Every plan has limitations. That means not everything will be covered. Take a look at each plan you’re considering so you know the costs, deductibles, copayments and overall benefits of the plan. It’s important to know the limits of a plan before you choose. For example, elective, cosmetic or alternative therapies are common treatments that are not generally covered by health plans when they are not considered medically necessary.
For a cost and benefit comparison please call us for a quote today, you can reach us at 818-264-1325.