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Your Guide Towards an Individual Healthcare Plan

Buying health insurance is a big decision and it is one that can have some serious repercussions if you do not choose correctly. That’s why you need to sit down and carefully go over all your options. Even though this is a difficult task, you are not alone. There are a lot of government regulations on your side that govern what your plan must include and you cannot be denied coverage. Now let’s take a look at everything you need to know when shopping around for coverage.

What is an Individual Health Insurance Plan?

An individual health insurance plan is coverage for those individuals who are not connected to job-based coverage. For example, you might decide to buy a policy for yourself straight from the insurance company or you can choose to get coverage from the state exchanges. One of the most important things you need to remember is that after the health reform bill was passed, insurance companies are no longer allowed to deny you coverage or raise your premiums due to a preexisting condition.

Some of the best things about the new laws is that they really cut back what the insurance companies can do. For example, previously, they could limit your benefits and demand you pay a lot of money out of pocket. All of this has been eliminated. Overall, the marketplace is now a lot user friendly and it is geared towards helping patients get covered regardless of their medical history. There are different types of plans that are provided by the government so let’s take a look at those next.

Do You Know Al of Your Choices?

There is a wide selection of plans available from the private insurance market and the public one as well. Let’s take a look at the latter first. There are 4 different plans offered which vary in the amount of the bill they will pay and your premiums:

  • Bronze – 40/60 split
  • Silver – 30/70 split
  • Gold – 20/80 split
  • Platinum – 10/90 split
Metal level Individual coverage Family coverage
Bronze $441 $1,082
Silver $481 $1,181
Gold $596 $1,426
Platinum $706 $1,460

As a general rule, the more of the bill covered by the plan, the higher your premiums will be. So, in what we saw above, while the Platinum plan may seem great, but it has its downsides. Still, you have to consider the tradeoff. If you have a chronic condition that requires many doctor visits or even trips to the hospital, it would be better for you to pick a plan that covers a big portion of your out-of-pocket expenses. The opposite is true for those people who are healthy and do not need all that much care. For them, there would be no sense in paying high premiums since the likelihood of them needing to use the insurance is very small.

Having said this, a lot of experts recommend that you overprotect yourself. The reason that you have insurance, to begin with, is because you don’t know what the future holds and you want to be protected from whatever life throws your way. So even if you did not need to go to the doctor last year at all, there is no guarantee that you will not need this year as well. Just keep this in mind before selecting your coverage.

Buying Your Individual Healthcare Plan

Ultimate decision that you end up making should depend on a wide variety of factors. We will cover those later on, but when you are just starting to look, you should only gather information. Later on whenever you have seen enough you can consider buying something.

There are plenty of websites out there that will give you all sorts of information about what each plan contains and for whom they are best suited for. If you would rather speak with a real person, you can call the customer service center and they will be able to answer all of your questions. Also, keep in mind that not every company will sell a plan via the state’s health insurance exchange, so you will have to do some research into all of the policies.

The insurance offered through the state exchange offers subsidies for qualified individuals and families depending on their income:

  • 2-person household - $67,640 maximum income
  • 3-person household - $85,320 maximum income
  • 4-person household - $103,000 maximum income
  • 5-person household - $120,680 maximum income

Generally, you will be able to get discounted insurance if you make less than 4 times the poverty line. You will receive your discount in the form of a tax break and you will be able to see the actual price with the savings as you are shopping.

When to buy an individual health plan

  • California – Oct. 15 to Jan. 15
  • Colorado – Nov. 1 to Jan. 15
  • D.C. – Nov. 1 to Jan. 31
  • Massachusetts – Nov. 1 to Jan. 23
  • Minnesota – Nov. 1 to Dec. 23
  • New York – Nov. 1 to Jan. 31
  • Rhode Island – Nov. 1 to Dec. 23

Compare and Contrast the Plans

The first thing you need to think about is how the plans are structured. If we think back to the four plans offered by the government, you will need to choose which one is right for you based on your health condition and economic situation. The choice comes down to spending. You will have to pay one way or another, it’s just that you will have to choose how and when. All of this will depend on your circumstances.

Next, think about the network. Do you have a doctor that you have been visiting for a long time, who you feel comfortable with, and receive consultations from? If this is the case, then you better make sure that they are within the insurance’s doctor network. If not, you will have to pay more out of pocket to see them. A lot of times you will see a great plan but your doctor is not within the network so you will have to decide how important that is for you.

The third thing to consider is what’s actually covered. For example, if you have a chronic condition that requires a lot of medications, then you better make sure the policy covers this. If you will need to buy some special equipment or need to see a specialist more than once a year, you need to find out if this is covered as well. The last thing you want to do is buy a policy and later realize that it only covers a fraction of what you need.

Finally, the cost. While you might be shopping around and experience some sticker shock, you need to remember that this is your health we are talking about here so there is no point in trying to save. If you would feel comfortable with having more coverage and you are able to pay the premium, then you should buy it. As we mentioned before, it’s always a good idea to have that extra protection behind in the event that something goes wrong.

The Bottom Line

While you may do a lot of research online into what all of the various plans cover, only you really know which plan is right for your individual situation. Given the health scare that we saw recently, we found out once again that the future is unpredictable and there is no need to roll the dice with your health. Therefore, do all of your research so that you can be informed about all of your options. You will find out all of the vast options that are available to you and if this is the case then why not go after something that you really feel comfortable with? In the end, the most important thing is that you find the best policy for your needs.

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