Individual Health Insurance

Are you self-employed or working for an employer that does not offer health insurance? With medical and healthcare costs constantly rising, not having health insurance to cover medical costs could prove financially devastating for you and your family. Individual health insurance plans can provide you with the peace of mind in knowing that your medical expenses are covered routinely and in the event of an emergency or catastrophic illness.

Basics of Individual Health Insurance

An individual health insurance plan is health insurance that you select and pay for yourself when you don't have access to a group or employer-provided healthcare plan. It is often referred to as direct-purchase health insurance, because you must purchase it directly from the insurer or other authorized representatives. You may purchase a plan that covers you individually or one that covers the members of your immediate family as well. There are many types of health insurance plans available for individuals. A few of the more common ones are:
  • Managed Care Plans -- These aim to provide care at the lowest possible cost. For plan participants to get the most benefit from one of these plans, and to spend the least amount of their own money while doing so, they must follow certain rules like obtaining specialist referrals and seeing only in-network doctors. The majority of individual managed care health insurance plans are Preferred Provider Organizations (PPOs). Participants pay monthly premiums and may also pay copays. Generally, these policies provide coverage for a wide range of services and treatments such as dental, vision, lab/x-ray, surgical, hospitalization, preventive care, prescription drugs, mental health, and skilled nursing.

  • Indemnity Plans -- Also called "traditional" or "fee-for-service," with indemnity health insurance, the insurer pays your bill after you have been treated. This type of insurance gives plan participants the greatest latitude when selecting healthcare providers and care facilities. The insured is responsible for monthly premiums, deductibles, copays, fees for non-covered services, and fees above what the insurer deems reasonable and customary for treatment. Like managed care plans, indemnity plans provide a variety of healthcare benefits.

  • Long-Term Care -- Covers services and support needed in the event of an extended disability due to injury, infirmity, terminal illness, or other causes. Long-term care plans are available in a wide variety of insurance vehicles, from PPOs to life insurance riders.

  • Basic Medical/Surgical -- This plan only provides coverage for physician visits and surgical procedures.

  • Major Medical -- Covers all medically-related expenses in and out of the hospital, including prescription drugs.

Purchasing Individual Health Insurance Plans

Individual health insurance policies differ widely in what they cover, their limitations, and their costs. It is recommended that you take the time to comparison shop, as well as to educate yourself on health insurance and your coverage rights. You will pay more for an individual plan than you would for a comparable group insurance policy. Additionally, most individual plans are less comprehensive than group plans; and insurers can impose more coverage limitations on individual policies. You will have to show proof of good health, coverage continuation, and a healthy lifestyle to qualify for an Indemnity policy. You may still be denied coverage for pre-existing conditions or have riders placed on your policy with any individual health insurance plan.

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