Individual and Family Health Insurance Frequently Asked Questions
Individual health insurance is changing rapidly and the options available to you are more tailored to your needs and budget. The Affordable Care Act (commonly called Obamacare) made it mandatory for everyone to have medical insurance or pay a tax penalty. To accommodate this new mandatory marketplace, the health insurance industry has developed a wider variety of plan designs and government assistance options that make individual coverage affordable for everyone.
The following questions will help you find top rated individual health insurance plans that meet your specific health care needs and budget. Contact us today to get expert advice about what coverage is right for you!
What is the “Subsidy” and how do I know if I qualify for it?
Will I have to pay more if I use tobacco?
Will I have to pay more if I have a pre-existing condition?
How many quotes should I get if I know what I basically want?
Can I get a health insurance quote online?
Are there health insurance plans that I can afford?
What is a Health Savings Account? Would That be Appropriate for Me?
What is the Difference between Group and Individual Health Insurance Coverage?
Are There Additional Coverage Plans I Should Consider?
What Types of Individual Plans are Available?
- Indemnity (Fee-for-Service, or FFS) Plans: These medical plans offer the greatest flexibility in choosing your doctors. The limitation with Indemnity plans exists in the amount of the reimbursement that an insured party can receive to cover medical expenses. The medical expenses reimbursement amount can range from a per day cost and set percentage to the actual costs of the medical expenses.
- Preferred Provider Organizations (PPOs): These plans contract with a network of hospitals and doctors who provide services at a negotiated rate. This means you have access to any PPO provider in the network, whether a primary care physician or a specialist. PPO members can go to doctors or hospitals that are not in the network but will have to pay a higher cost for doing so. This is a great plan if you are looking for insurance that is both affordable and flexible.
- Health Maintenance Organizations (HMOs): With these managed care plans, you will have a primary care physician (PCP) who is responsible for managing all of your health care. If you need to see a specialist or someone else in the network, you need a referral from your PCP. Treatment received outside the network is generally not covered, or is covered at a significantly reduced level. Point of Service (POS) Plans: These medical plans are a combination of the PPO and HMO models. Like an HMO, there is a PCP providing referrals to in-network doctors. Like a PPO, you can see providers outside the network and pay more of the cost.
What Should You Consider When Choosing a Health Plan?
- Health Care Needs: The first consideration when selecting a health plan is determining what your specific needs are. How often do you go to the doctor? Will your needs change in the next year, such as starting a family? Are you receiving on-going treatment? Do family members need their own individual health plans to get the coverage they need?
- Hospitals and Doctors: The second consideration is the network of doctors and hospitals in the plan. If you like your doctor, is he or she in the plan? Are the doctors and facilities conveniently located near you? Do you have freedom to see whomever you want?
- Costs: The third consideration is the cost of your plan, and what benefits package makes sense based on your finances. Under the Affordable Care Act, many health insurance plans for individuals now have bronze, silver, gold and platinum benefit levels that indicate the level of coverage (and associated costs) the policyholder will have. When considering the options, be sure to see what each plan does or does not cover and what would be your out-of-pocket cost. Before making a decision, consider the various plans' monthly premiums, deductibles, copays, coinsurance and other expenses. Are you eligible for a federal subsidy or tax credit to help pay for the health insurance?