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Individual Health Insurance: Help When You Need It

Anyone who has been on group health insurance and has suddenly needed to find individual insurance has probably felt a bit overwhelmed. When you are trying to interpret the terms yourself and are trying to get a reasonable price for the medical coverage you need, you are likely to think the best part of your former job was the health coverage. Fortunately, while it may not be simple, finding an affordable individual health insurance plan is not impossible. We can help you find the affordable individual health insurance plan that best fit your needs, whether you want a low priced HMO or PPO or would prefer a traditional insurance that lets you choose.

The following points should be on your list of questions to ask the company or agent with whom you apply for a policy.

  • What is the deductible? Can you lower your premium by opting for a higher deductible?
  • How are claims paid? The amount the company will pay for each claim could be "as charged," meaning it will pay whatever the doctor charges after your deductible is met. The other option is "usual and customary," which is actually a payment schedule designed by the government for use when determining Medicare payments. While most insurance companies pay the doctor more than Medicare pays, they still usually base the payment on the "usual and customary" rate schedule.
  • How quickly are claims paid?
  • Pre-existence clause. Most private insurers have clauses that exclude payment for a condition you already have. Check to see how long you must have the insurance before pre-existing conditions are covered.
  • Is pregnancy included? At what rate of coverage? Does it require an additional rider?
  • Are organ transplants covered?
  • Does the policy include any wellness benefits such as a membership in your local fitness organization?
  • How soon can you expect a rate increase? Are you likely to get a rate increase if you have a major illness?
  • What type of policy is it? Is it a PPO, HMO, traditional Fee for Service, or something else?
  • If the policy is the type that uses a network of caregivers—such as an HMO, is your doctor in the network?
  • Are prescription drugs included? At what copay?
  • What are the restrictions for surgery or emergency care? Is prior approval required in order for the company to pay for care?
  • What is the lifetime maximum?

The most important part of looking for individual health insurance is in understanding what you want and need. Too often, people do not know what they have until they try to use it and find that what they thought they had simply isn't in the policy or is written differently than they expected.

Most health insurance companies will allow you to apply and receive a policy before sending in the first premium. This will give you a chance to go through the policy carefully and to ask questions about anything that seems ambiguous. Be sure to take advantage of our free service to assist you in finding the policy that best fits your needs.