Buying individual health insurance is a big decision. It’s complicated, it’s expensive, and it can have big financial implications. Like a lot of things, it’s easier if you break the job into smaller tasks and work your way through them.
Make a list of services you and your family may need.
Consider your age, gender, and family medical history. Do you have any ongoing health conditions? Do you use any medications on a regular basis?
At a very minimum, plan to buy a high deductible health plan, which is also referred to as catastrophic coverage. In a nutshell, a high deductible plan offers a lower premium, and you pay most routine expenses out of pocket. If you have a serious accident or become seriously ill, your insurance coverage will kick in once you reach your deductible.
Learn how your state regulates insurance.
Click on your state, and then take some time to explore. Most state insurance sites feature:
- Tips for comparing health insurance policies.
- Companies authorized to sell health insurance where you live and which of those companies sell individual policies.
- Warnings about recent scams or companies that have been generating consumer complaints.
- Information about state mandates – what a health insurance policy must cover in your state.
Know your rights under reform.
The Affordable Care Act (ACA) is already working in favor of health care consumers. For example, insurers are now prohibited from imposing lifetime limits on most benefits. See HealthCare.gov for ACA provisions implemented so far.
You can contact an agent or get online quotes. Be aware that working with an agent may not give you the full picture. Agents generally work with a subset of the available insurance companies. Using an online site will generally show you more options to consider.
Don’t forget out-of-pocket costs.
Consider the premium and cost-sharing requirements, like deductibles, copayments or coinsurance. If the policy doesn’t cover the services you’re most likely to need, it’s not a bargain. On the flip side, you may end up paying more than you have to if the policy includes things you don’t need.
Consider what the policy includes …
Types of services – Here are some common health care services to consider when evaluating health insurance coverage:
- Hospital care
- Surgery (inpatient and outpatient)
- Office visits to your doctor
- Emergency room visits
- Maternity care
- Well-baby care
- Medical tests
- Mental health care
- Dental care and braces
- Vision care and glasses
- Prescription drugs
Facilities and Doctors – What hospitals, doctors and clinics that are in network for the policy you’re considering? Do you need a referral to see a specialist?
Medications – If you regularly use a certain medication, is that drug on the plan’s formulary or preferred drug list?
… and what the policy doesn’t include
Health insurance policies may have a list of services that are specifically excluded. When evaluating a plan, look for limitations, exclusions, and restrictions.
Read the fine print.
When you think you have a winner, READ the policy. Read all of it. Look up any terms you don’t understand. The details matter.
Consider a risk pool.
If you can’t find the coverage you need because of a pre-existing condition, look into the Pre-Existing Condition Insurance Plan. It’s a temporary program operating until 2014 when plans will no longer be able to refuse coverage to people who have pre-existing conditions.
Check the state of your state coverage.
If you can’t afford coverage, look into the government health insurance resources for your state.