Individual Health Insurance

Individual Health Coverage for the Here and Now

In her last post, Melissa urged individual health consumers not to wait until health care reform is completed before getting coverage. I'd like to build on this by sharing some hard numbers from a survey sponsored by eHealth, Inc., which measured consumer expectations following the passage of legislation.

eHealth's Health Reform Survey found that 39% of the uninsured respondents would wait for health reform legislation to be fully implemented before researching and buying health insurance, and 44% believe there is "no risk" in going without health insurance coverage until government programs become available.

Additionally, a substantial number of the uninsured respondents expect the following reforms to be fully implemented in 2010:

• 62% expect to have access to private insurance regardless of any pre-existing medical conditions
• 56% believe the government health insurance exchanges will be up and running
• 56% expect to receive subsidies to help cover the cost of health insurance

It's critical for consumers to understand that the timeline for implementation of the various health reform provisions span through 2014, and some reforms are slated for 2015 and beyond. Delaying the important task of buying health insurance puts uninsureds at tremendous risk - to their physical and financial health.

 

That's why there remains a need for individual health insurance. People need coverage to protect their physical health and financial stability, and waiting until health care reform is completed is not the answer. While health care reform in imminent, there's a need in the here and now for coverage.

Finding the Right Individual Health Insurance Plan, Part 3: More Questions to Ask

You've purchased an individual health insurance plan with the right combination of benefits that works you're your budget. When it comes down to using your plan and managing your health care dollars, becoming more engaged in medical decisions and asking questions helps ensure you're maximizing your budget.

Since you'll be paying for many of the medical services covered by your plan until you reach your deductible, you'll probably want to make sure your treatments are cost-effective. If you have a PPO plan, you'll automatically receive negotiated discounts by using network providers and hospitals. But that doesn't mean you shouldn't ask questions about how your health care affects your out-of-pocket costs, such as:

"Is this doctor in my PPO network?"
"Can this procedure be done on an outpatient basis?"
"Is this really an emergency?"
"Is there a generic available in place of this brand-name drug?"
"How much does this treatment cost?"

You may find the answers to these types of questions result in your finding more affordable alternatives. They might even open up additional dialogue with your health care providers in which you'll learn more about how services are priced, how payments can be negotiated, and how you can budget for various future health care costs.

Asking questions and getting more involved in your health care decisions will impact more than the bottom line. You'll also gain a better understanding of your body, medical conditions, treatments and options. This will naturally improve the quality of your care - and that gives you peace of mind that doesn't have a price tag.

For more information on being an empowered patient, visit the U.S. Department of Health and Human Service's Agency for Healthcare Research and Quality website.

 

 

Is Being Uninsured Worth the Risk?

A friend of mine, "Mike," is about to change jobs. He has a waiting period of three months before coverage under his new employer's plan begins. That means he has a three-month period in which he'll either pay to extend his benefits under COBRA, buy individual health coverage, or go uninsured.

At first, Mike was inclined to go uninsured, save the money, and "hope and pray" no big medical expenses arise. He doesn't plan on going to the doctor during his hiatus from coverage, and his wife is covered through her job and they have no other dependents to worry about.

He knows I work in the health insurance industry so he asked me for my opinion: "Do I really need insurance before my new group coverage begins? Can't I pay out-of-pocket for any medical expenses that come up?"

"Not so fast!" I warned. Being uninsured can cost a lot more than paying health insurance premiums. Mike may be able to pay for a doctor's visit or prescription out of his savings, but what if he's in a serious accident or develops a serious illness? Without major medical coverage he'd be responsible for paying all of these unexpected - and costly - medical bills on his own.

Mike decided it's not worth the risk. He doesn't want to become a cautionary tale. He's purchasing a short-term individual health plan to fill the gap. It's less expensive than COBRA, and far less expensive than taking on the risk of huge, unexpected medial bills he's not planning for.

If you, like Mike, find yourself between jobs, ask yourself if being uninsured before your new group plan takes effect is a risk you're willing to take. Individual health coverage can provide peace of mind during this time.

Visit Celtic's Individual Health Insurance Learning Resources page to learn more about how individual health insurance can meet your coverage needs.

Open-Enrollment: A Good Time to Consider Individual Health

Economic times are tough, so lots of people are looking for ways to save money on their health insurance. Many companies need to save money, too, and they're shifting more of the costs of health insurance to employees. This may make group coverage more expensive for those who get coverage through their work.

Open enrollment, which is taking place now in most companies, is the perfect time to compare your group coverage with what's available to you in an individual health plan. Start by looking at the costs, benefits and eligibility requirements of your employer's 2010 group plan.

• Does your group health plan require your pay higher copays or higher deductibles in 2010?

• Is the amount you're paying for health insurance going up?

• Do you have the opportunity to enroll your spouse and children under your plan?

If you don't have access to affordable, adequate group health coverage, consider quoting individual health insurance. An individual health plan may offer you lower monthly premiums, more deductible choices, and options to cover spouses and children.

To find out if an individual health insurance plan might be the solution to the affordable coverage you need, explore the many resources at www.celtic-net.com and get a quote today!

Individual Health Insurance Basics, Part 2

My last post went over some basic information about individual health insurance. This time I'd like to dig deeper into how plans are priced.

How much does an individual health insurance plan cost?
Cost is an important consideration when buying health insurance. Running quotes is the fastest way to find out what a policy might cost you. Generally speaking, a plan with more coverage will cost more than a plan with less coverage. You may find the benefits in an individual policy are simpler than in a group plan. And, there is usually a greater cost-sharing element. For example, you might have to pay co-payments, deductibles and coinsurance before the insurance plan pays any claims. But the more cost-sharing you are willing to take on, the less you pay for the insurance premiums.

Most people just want the peace of mind that they have coverage should they be diagnosed with a serious illness or have a bad accident. Many do not want or need an all-inclusive or very comprehensive plan because these tend to be more expensive. That's why a basic benefit plan works for many people.

Here are a few insurance definitions you might find useful:

Annual Plan Deductible: The dollar amount that the insured must pay out-of-pocket each year before the insurance company will make any benefit payments for claims.

Coinsurance: The percentage an insured is required to pay for a medical claim, after the co-payment or deductible. For example, if you choose an 80/20 plan, you pay 20% of the eligible covered amount and the insurance company pays the other 80%.

Copayment: The amount specified in your plan that an insured person pays to a provider for a specific health care service at the time it is received. For example, an insured may pay a "$35 office visit copay".

Out-of-pocket maximum: The maximum amount that an insured is required to pay under an insurance policy per year.

Visit Celtic's Individual Health Insurance Learning Resources page to learn more.

Individual Health Insurance - Where Do I Start?

"Where do I start?" You might be asking yourself this question when it comes to understanding individual health insurance. Maybe you've always gotten health coverage from your employer or as a dependent on a family member's plan and now you're looking for insurance on your own. Or maybe you have an individual health plan now and you want to make sure you understand how it all works.

I'll bet you're asking yourself a lot more than "where do I start?" We all have a lot to think about while making health care decisions. That's where this blog comes in.

My fellow Celtic bloggers and I want to make it easy for you to make smart choices, so we'll give you lots of tips and tools to help you understand your options. And, of course, we'll address many of the health care topics you're interested in.

We hope you'll visit us often to learn about individual health insurance. Keep informed and explore the answers to your questions - whether they're about coverage options, your health insurance budget, or even staying healthy.

So if you want to learn more, this is a great place to start!

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