CHOOSING INDIVIDUAL COVERAGE HEALTH INSURANCE PLANS

Finding affordable health insurance or healthcare can be a difficult task. One option to consider is to purchase an Individual Health Insurance Policy. “Individual" health insurance means the plan is not offered through an employer, but is purchased directly by an individual or family.

If you decide to purchase individual health insurance, the insurance company or health plan will consider your age and your past and present health “pre-existing conditions?to determine your premium. A “pre-existing condition?is any medical problem that was diagnosed or treated within a certain time frame before a new individual health insurance policy goes into effect. The majority of employer-based health plans do not have pre-existing conditions exclusions.

However, an individual health insurance plan can be less expensive than COBRA coverage for people who lose coverage through their job. If you do have a pre-existing condition, continuing your present plan through COBRA may be a good option. If you are relatively healthy, obtaining a less expensive individual health insurance policy is worth considering (although if you develop a serious health condition your premiums may increase when the policy renews). For instance, it may be more cost-effective to enroll your children in an individual health insurance plan than to cover them as dependents through your employer’s health benefit.

Questions to Ask before Choosing Individual Health Insurance:

• What type of plan is it? Individual health insurance plans come in a variety of flavors. There are HMO’s, PPO’s and traditional fee-for-service plans (for more information, request CareCounsel Tip Sheet ?“Choosing a Health Insurance Plan?.
• Compare coverage between individual health insurance plan choices and between any employer-paid options. Many employer-paid health benefit programs offer richer coverage than do individual policies. Pay particular attention to annual and lifetime maximums in case you develop a catastrophic illness. Also review the fine print of the health insurance evidence of coverage to verify limitations and exclusions.
• If you’re considering a managed care plan (HMO or PPO), make sure the doctors in the plan's network match your needs and preferences. Call up a couple of doctors and see if they are taking new patients through that insurance plan.
• Call the health insurance plan’s member services department to measure how responsive, timely and knowledgeable the staff are.

How do I find an Individual Health Insurance Plan?

There are various ways in which you can find individual health plan coverage.

• One of the easiest ways to compare plan options and purchase health insurance is by logging on to the Internet. Firms like eHealthInsurance.com (http://www.ehealthinsurance.com) let you make side-by-side health plan benefit & cost comparisons between a variety of health insurance options available in your state. You can even complete the paperwork to purchase the insurance directly on-line.
• Another option is to contact a local health insurance agent/broker offering policies for individuals. If you do not want to “do the leg work,?this method may be for you. Consult your local yellow pages and look for brokers that sell health policies under the “Insurance?section.
• Based on the information that you give the broker, i.e., type of plan, amount you are willing to pay, etc., they will narrow your selection of plan choices. But remember that the broker receives a commission from the health insurance program when you enroll and his/her suggestions may be influenced by financial sales incentives offered by the health insurance providers.
• Some people prefer to contact the individual health plans on their own. This method does take more time, but ultimately you may feel more involved in the selection process. You can look up your local choices under “Health Plans?in the yellow pages or visit their web sites.

Other Options:

There may be other options available to you and your family, if you qualify. National and/or government-sponsored programs can offer low-cost or no cost healthcare benefits. Many states offer “special?programs designed for the healthcare needs of children or pregnant women, such as Healthy Families, Child Health and Disability Program (CHDP), Kaiser Cares for Kids, etc. Check with your local or state government for such programs and their eligibility requirements.

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