Individual Health Insurance Options
You have a number of options when shopping for
individual health insurance:
 | Fee-for-Service Insurance |
| Managed Care Plans |
| Open Enrollment in Managed Care Plans
|
| Association-Based Health Insurance
|
| High-Risk Pools |
Fee-for-Service Insurance
A fee-for-service insurance policy (also called
indemnity insurance) is a traditional kind of health insurance. It
pays a part of each medical service you get, such as doctor visits
or hospital stays. You pay the rest of the cost. You can go to any
doctor or hospital you choose. However, you usually pay a higher
monthly cost for your medical care than if you were part of a
managed care plan. Traditional health insurance is less common than
it used to be.
Managed Care Plans
Many people get health insurance through a managed
care plan, such as a health maintenance organization (HMO) or
preferred provider organization (PPO.)
| In managed care plans, health insurance
companies contract with doctors and hospitals to provide health
care to its members. These doctors and hospitals make up the
plan's network. |
| In managed care plans, you may only be able
to see the doctors and hospitals that are part of the plan's
network. Some plans, like PPOs, allow you to use doctors and
hospitals outside the plan network, but you usually pay more.
|
| In HMOs, your visits to the doctor are
pre-paid by the plan. You only pay a small copayment, for
example, $10 to $20, each time you visit the doctor.
|
Open Enrollment in Managed Care Plans
Some states require managed care plans to have an
"open enrollment" period each year. Open enrollment usually is a
one-month period during which managed care plans must let people
join, even if they have an ongoing, serious medical problem. This
can be a very helpful option if you have not been able to get health
insurance because of a medical problem. You can sign up for a
managed care plan during an open enrollment period without having to
get medical exams to prove you can be insured.
FYI: A few states
require insurance companies to offer their plans to people who have
not been able to get health insurance because of their health. This
option can apply to more types of health insurance than just managed
care plans. Check with your state insurance department to learn the
rules in your state.
Association-Based Health Insurance
You might be able to get health insurance through
a trade or professional association. Many professional, community,
and religious organizations offer their members health insurance
coverage at group rates. If you are a member of any trade or
professional association, ask if it offers health insurance
coverage. Find out:
| How complete the coverage is |
| How much of your medical expenses from
routine doctor visits and prescription drugs to major surgery
will the insurance cover |
| What it will cost each month |
| If it covers family members |
Your state insurance department can tell you what
your rights are under association-based health insurance plans.
High-Risk Pools
In some states, high-risk pools might be a source
of health insurance for people who have not been able to get health
insurance because of a serious medical condition. High-risk pools
are considered the last resort, when all other attempts at getting
health insurance haven't worked out. To get health insurance through
a high-risk pool:
| You must have been refused health insurance
coverage by at least one or two insurance companies, or
|
| You could not find a health insurance plan
with a monthly premium less than the monthly premium in the
high-risk pool. |
Your state insurance department can tell you if
your state has a high-risk pool program.
Health Insurance Brokers
If you are having a hard time deciding which
insurance plan is best for you, some people talk to a health
insurance broker. An independent broker sells many different kinds
of health insurance.
Other brokers sell plans from just one company, so
it's best to talk to a few such brokers before choosing one. Be sure
you understand how the broker is paid - whether you pay or the
insurance company pays the broker a commission. That may affect the
plan that the broker recommends. If you decide to use a broker, make
sure the broker will work in your best interest, and remember that
sometimes this costs more and not all insurance products are
available through a broker.
Other Types of Policies
There are other kinds of insurance policies that
should not be mistaken for comprehensive health insurance. Specific
disease policies, such as "cancer policies," pay for care only for
the specific disease. Hospital indemnity policies pay you a set
amount of money for each day you are in the hospital.
These policies may sound good but don't really
help with your health care costs. You would be better off checking
out the other insurance options.
