Individual Health Coverage

Mary Gormandy White
Doctor with Apple

Health care is expensive. If you do not receive medical insurance from your employer, you may want to consider purchasing individual health coverage. This coverage can protect you financially and ensure that you can afford medical care should the need arise. Individual coverage is slightly different than the group coverage that most employers offer. Though the coverage can be similar, the premiums for individual plans are usually much higher than the premiums for group plans. Those with individual coverage pay premiums that are more in line with their expected health costs.

Obtaining Coverage

You can purchase individual health policies through insurance companies, agents, or brokers. Policies can be purchased for both individuals and dependents, but obtaining coverage isn't always easy as there is no guarantee that your application for a policy will be accepted. In some states, insurers have the right to deny you coverage if you have a pre-existing medical condition. They may also have the right to charge you a higher premium or attach exclusions to your policy based on a review of your medical situation.

If you do not currently have a medical condition and if you have not been treated for a condition for the past ten years, you have a better chance of obtaining a policy with low premiums. You can also use previous group health coverage to qualify for individual health coverage if:

  • You have had group coverage within the past 60 days.
  • You have had previous group coverage for at least 18 months.
  • You are no longer eligible for other types of insurance coverage, such as COBRA, Medicaid, or Medicare.

Plan Types

In most cases, individual health plans offer the same type of coverage that group plans offer. Your budget, physician preferences, and coverage needs will all help determine which plan is best for you. Types of plans include:

  • HMOs - Health Maintenance Organizations
  • PPOs - Preferred Provider Organizations
  • POS - Point-of-Service Plans
  • Traditional Fee-For-Service Plans
  • Indemnity Plans

Individual Health Coverage Providers

When looking for individual health coverage, you should always take time to shop around and compare prices. Premiums for similar insurance products from different insurers can vary by as much as 50 percent. To get the best deal possible, take time to comparison shop and speak with different agents and brokers. An agent or broker who is familiar with individual health insurance can help you decide what type of coverage best meets your needs.

If you are having trouble locating a provider, here are some companies who offer individual health plans:

Money Saving Tips

Individual health coverage can be expensive. To lower your costs, you can look for comprehensive inpatient/outpatient plans with higher deductibles--just make sure that you can pay the deductible if you have to.

Also, make sure you understand exactly what your policy will cover. Ask about doctor's visits, annual check-ups, X-rays, hospital stays, and prescription drug coverage before you purchase a policy. Knowing what type of coverage you have before an emergency occurs is very important.

If you need help estimating your future health costs, visit The Agency for Health Care Policy and Research. This agency offers evaluation guidelines for annual premiums, deductibles, co-pays, annual limits, and out-of-pocket expenses.

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Individual Health Coverage