When shopping for an individual health insurance policy, it pays to do your homework. Ask yourself the following key questions:
- How important is it that I keep the doctor I have now?
If you have a particular physician in mind, that might dictate whether
a PPO or an HMO is right for you, depending on whether he or she
belongs to that insurance company's network.
- Do I prefer certain specialists?
Keep in mind that some plans limit not only your visits but also who
you can see. If you want to see an acupuncturist or chiropractor, be
sure to ask your insurance agent or broker about coverage for these
services. Psychotherapy and other mental-health services will probably
have specific guidelines and limitations as well. - What are my health insurance goals?
If you want
a comprehensive plan — and don't want many of out-of-pocket expenses —
an HMO provides a very cost-effective way to cover you from womb to
tomb. But if you're in your 20s or 30s, have no children and some extra
savings, you can save by buying a policy that covers only catastrophic
illnesses. Remember, though, you'll have to pay out of your own pocket
for every routine doctor's visit or laboratory test.
If
you can afford to pay for routine care on your own, look for
comprehensive inpatient/outpatient plans with higher deductibles rather
than trimmed-down hospital/surgical plans. A hospital/surgical plan
might cost up to 40 percent less, but if you end up in the hospital,
the last thing you need is to worry about how you're going to pay for
your follow-up care once you get out of there. If you are leaning towards a more well-rounded plan,
make sure you understand what youre getting. Read the fine print. Will
your plan pay for X-rays? Will it cover your doctor's visit if you have
the flu? Will it cover prescription drugs? The Agency for Health Care Policy and Research offers
guidelines for estimating your future health care costs and comparing
several policies. Consider the annual premiums, the deductibles,
co-payments, annual limits, and maximum out-of-pocket expenses. This
should give you a good idea of what your yearly costs will be for each
policy. Don't let a "cheap" policy fool you. Make sure you check
whether the "best buy" will give you access to the kinds of services
you might require.
Depending
on the state in which you live, your options might be more varied — and
even more confusing. In Florida, for instance, a self-employed, sole
proprietor can be eligible to buy health insurance as a business — even
a home-based one — if he can prove that he's been in business for at
least 30 days.
If you live in a state that does not
offer these "group of one" insurance policies, you might still qualify
for a group rate if you own a business and have at least one other
partner or employee. Does your spouse do some bookkeeping for your
company? That's a two-person business, eligible for a group rate and a
group policy. But even if you're not in business, don't consign
yourself just yet to buying an individual policy if you prefer group
insurance:
- If you're leaving a group plan, ask if the insurer will convert it
to an individual health plan. The rate will be higher than your group
plan but likely less than if you bought a policy on your own.
- Can your spouse get a group plan at work? If so, he or she can add you on.
- You may be able to find a group plan through your fraternal
organization, alumni association, trade association, the AARP (if
you're over 50), or your chamber of commerce. All of these are
potential sources of group health insurance.
Finding a cost-effective individual health policy
can be tricky but it's not rocket science. Talk to other people around
you who are in the same circumstances. Do your homework and you'll find
the health insurance policy that's right for you.
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