We want to make it easy for you to learn about your health plan alternatives and buy an individual health insurance coverage that will work for you.
“Keep in mind if you do not have a mayor medical coverage to protect you from unexpected medical cost, you would be responsible for paying all these medical bills on your own”.
What is individual health insurance?
Individual health insurance is private coverage that you can buy directly from an insurance company
If you are on this group you should consider finding an Individual Health Insurance:
People between jobs Self-employees Entrepreneurs People in Cobra Part-time employees Workers whose employer don’t offer group coverage Early retirees New employees waiting for their group health coverage to begin
It’s helpful to compare the health plan you are considering and to think about how each feature affects the plan cost. Things to think about:
Plan Benefits Monthly premium Co-pays, Deductible, Coinsurance, Max-out-of pocket Plan convenience: Access to doctors and hospital in your area Additional benefits: Dental, Vision Supplemental accident, etc Pharmacy Maternity Exclusions and limitations
Tip to lower premiums:
Consider a High deductible: Choosing a higher annual plan deductible will lower your monthly premium
What types of plans are available?
HMOs (Health Maintenance Organization). HMOs are one of the most affordable health plans available, and they offer comprehensive coverage. HMOs create networks of doctors, specialist, pharmacies, hospitals, and other care providers. Most HMO networks consist of thousands of health care professionals, ensuring you’ll have convenient access to medical care when you need it. PPOs (Preferred Provider Organization). PPOs plans are the most popular in the Individual and Family market. Like the name implies, with a PPO you’ll need to get your medical care from doctors or hospitals on the insurance company’s list of preferred providers if you want your claims paid at the highest level. It’s up to you to make sure that the health care providers you visit participate in the PPO. Services rendered by out-of-network providers may not be covered or may be paid at a lower level. Health Savings Account (HSA) Plans. There are 2 parts to HSA coverage: a high-deductible plan and a Health Savings Account. The high-deductible plan provides catastrophic coverage and features low monthly premiums. The HSA is a tax-free savings account where you save money to pay for routine medical expenses. Fee for Service (FFS) Plans. The FFS plan is the traditional form of individual health insurance. It works very simply – you get the care you need, then you’re reimbursed for a percentage of the cost.
COMMONLY USED HEALTH CARE WORDS:
Here are some basis terms that you should know if you are looking for an Affordable Health Plan.
Premiums:
Your premiums are payments you make to keep your plan in effect. Usually, premiums are paid each month. Premiums are set by your insurance company based on factors such as age, sex, health status and the zip code where you live.
Copayments (Co-pay):
A flat per service charge that plan members are responsible to pay for services such as Doctors visits or prescriptions.
Deductible:
Is the dollar amount you’ll be responsible each year for eligible health expenses before the plan begin to pay benefits for covered services. Most individual health insurance plans let you choose your own deductible.
Today Deductibles: $500, $1000, $1500, $2000, $2500, $3000, $3500, $5000, $7500, $10000
Coinsurance:
Is a percentage of the company contracted rate to an in-network provider or a percentage of the cost from an out-of-network provider that the member is responsible for. Coinsurance is similar to a copayment, except it’s expressed as a percentage rather than a dollar amount. A coinsurance rate of 70/30 means you’ll be responsible for 30% of a medical bill.
Examples of Coinsurance: 100/0, 90/10, 80/20 and 70/30.
In-Network Provider:
Any health care provider (physician, pharmacy, hospital, etc.) that participates in the company network.
Out-of-Network Provider:
Any health care provider (physician, pharmacy, hospital, etc.) that does not participate in the company network.
Impatient Care:
Care given to a plan member admitted to a hospital, hospice, skilled nursing facility or rehabilitation facility.
Outpatient Care:
Any health care service provided to a plan member who is not admitted to a facility.
Out-of-Pocket cost:
Copayments, deductibles, coinsurance or fees paid by plan members for health services or prescriptions.
Out-of-Pocket Maximum:
The most plan members will pay per year for covered health expenses before the plan pays 100% for the rest of the year.
“Making any mayor purchase can be difficult. But choosing individual health insurance can be particularly difficult because it touches the things that matter most: your family’s health and finances”
The most important desicion is to find a licensed agent in your area that help you sort out all the details of a health insurance plan – and help you with the application process.