If you are self-employed, or otherwise in need of individual health insurance coverage, how do you go about finding the best plan?
1. Learn the language:
HMO – Health Maintenance Organization. This is a very structured plan where you pick a PCP (Primary Care Physician), the doctor you see first for everything. The PCP refers you to a specialist.
PPO – Preferred Provider Organization. This is less restrictive than an HMO. You self-refer to any physician in the network for care.
Indemnity Plan – The old traditional plan before managed care. You go to any doctor or hospital. There are not many of these left, and they cost the most.
Hospital/Surgical Plan – These plans cover the basics with few bells and whistles. Some provide riders to make them look like major medical plans.
MSA – Medical Savings Plan – These plans were designed by Congress. You have a high deductible health plan coupled with a tax-deductible savings plan.
Temporary Health Insurance – A great low cost alternative for those needing coverage for one to twelve months or who cannot qualify for long term coverage.
The above ary very general descriptions to help explain the different options. Not all plans are available in all states.
2. Select the best type of plan for you:
This will depend on the length of time you need the coverage; how much money you have in savings or are willing to risk; your plans for having children; the doctors your prefer; cost; and most importantly your health.
If you are planning a family – Having maternity coverage is a must. An HMO will almost always provide the lowest cost, as maternity is built into the cost.
If you are between jobs – A temporary plan is the best way to go.
If you prefer a particular doctor or hospital – A PPO may be the best way to go.
If money is tight – A Hospital/Surgical Plan, HMO, Temporary Plan, or high deductible PPO may be options for you.
If you want complete freedom – and money is no factor, then an Indemnity Plan is best.
If you hardly ever use your plan – and you wish you had all the money back, then an MSA may be best for you.
If you have minor problems – that would be pre-existing conditions with most plans, an HMO might not consider these as problems.
If an HMO will not take you – a PPO, Indemnity, Hospital/Surgical or MSA may take you, but rider the condition.
3. Find out what it will cost:
To find out what it will cost, contact an agent in your state.
To avoid any surprises at claim time, it is important to provide accurate information. Do not give an insurance company an excuse not to pay!