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Health Insurance Buyer's Guide

Five Steps to Buying Your Own Health Insurance
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Health Insurance Buyer's Guide

Step Three - Assess Your Needs


Selecting the best health insurance plan for your needs means making an informed choice and knowing your personal priorities. Is budget most important? Which benefits do you really need? Consider the following questions.


Five key questions to help you assess your needs:


1. Do you maintain a savings or do you live paycheck to paycheck?
Why it matters: If you don't maintain a cushion of funds in the bank, you're going to want a health plan with a low deductible, or none at all. If you do keep a savings account and can afford a higher deductible if necessary, you may be able to find a plan with lower monthly premiums.

2. How often did you visit the doctor last year?
Why it matters: If you visit the doctor regularly, it may make sense to pay a higher monthly premium in order to keep your office-visit copayment and deductible low. If you rarely visit the doctor, maybe you don't need robust coverage for preventive care.

3. How much did you spend on health care last year?
Why it matters: If you spend a lot on health care, it's important to know what you spend it on and if you expect to spend at the same pace. If these are recurring costs (for prescription drugs, for example), make sure that the plan you select covers these services. If you don't spend much on health care, then you could save money with a plan that provides less generous coverage for office visits or prescription drugs.

4. Do you have any pre-existing medical conditions?
Why it matters: Some pre-existing medical conditions (like heart disease, cancer, or diabetes) can make it difficult to get approved for Individual and Family coverage. If you're concerned, a licensed eHealthInsurance agent can help direct you to insurance companies more likely to approve your application. Call 1-800-977-8860 to talk to an agent.

5. Are any specific benefits necessary or irrelevant?
Why it matters: If you're a regular user of prescription medication, make sure you find a plan that covers prescriptions at a copayment level you can afford. If it's possible you or your spouse could become pregnant, pay close attention to maternity benefits too. If you don't need prescription drugs or maternity benefits, you could save money. If you were recently laid off or voluntarily left an employer, you may have more than one choice when it comes to finding health insurance. By understanding your needs and situation you have a better chance of finding the coverage that works best. Here are a few options:
  • Your spouse's plan - Learn how much, if any, your spouse's share of the premium would increase if you join the plan.
  • COBRA coverage - COBRA allows you to temporarily extend coverage under your employer-sponsored health plan at your own cost. It's a good choice if you have a pre-existing medical condition, since you can't be declined based on your medical history. However, many people find COBRA prohibitively expensive.
  • Individual and Family plans - Before you decline COBRA, take a look at the Individual and Family options in your area. You could even apply for an Individual and Family plan and use COBRA as a back-up just in case.
  • Public options - Every state offers public programs and plans for individuals or families struggling financially or unable to get approved for coverage elsewhere.
To find more information about COBRA and a calculator to help you understand the difference in cost between COBRA coverage and Individual and Family plans, visit our COBRA Learning Center online.
 
"What if I have a pre-existing medical condition?"
In most states you can be declined for Individual and Family coverage due to a pre-existing medical condition. However, you may still have options. Talk to a licensed agent at eHealthInsurance for help. If we can't find an insurer likely to accept you, we can help direct you to government-sponsored solutions in your state.

"How Does Individual and Family Coverage Compare with Employer-sponsored Coverage?"
It differs in several key ways:

Pricing: Pricing is based on an individual or family's specific needs and medical history and can vary from state to state.

Choice: An employer may offer one or two options, but there may be dozens of Individual and Family choices with a range of rates and benefits to match your needs and budget.

Portability: Individual and Family health insurance is not tied to your job, so it can stay with you as long as you like. However, if you move to another state, though, you will likely need to get a new plan.

Eligibility: Be aware that in most states it is possible to be denied coverage for an Individual and Family plan based on your medical history.