Where to find Affordable Individual Health Insurance
64An In-Depth Video on the Material Discussed
I would be hard pressed to find a friend as devoted as my friend Lily. Despite how insignificant or great each hardship or hurdle was that needed to be overcome, she was there for me in more ways than one. She was there through financial strain, competition woes as an athlete, breakups and various other stressors.
Lily herself had harder financial difficulties, aggravatingly tumultuous issues with her former boyfriend - and a son to raise as a single mother. However, she never complained or asked for help - she only offered her own advice and assistance. If someone was short money, she'd scrimp from deep in her pockets to pull it out. That was who and what Lily was: a nurturer to her friends through and through.
The only time I ever heard Lily voice concern, however, was when she lost her job and was seeking individual healthcare for her and her son. Bryson, her hyperactive, giggly little boy, had a tendency to often get sick. The stress ate away at her, and she turned to me for advice, simply because she knew I would research the answers extensively until I found a logical conclusion to match her need. And that I certainly did.
Individual healthcare undoubtedly can be expensive. Whether or not it is affordable for you depends on your financial needs and the amount you have available to pay premiums, deductibles, and co-pays. However, keep in mind: your health is your most precious asset. It deserves your absolute attention. There are very few things, financially, that should compete with it.
Getting Down to the Basics
Essentially, there are two types of health insurance: Indemnity Plans and Managed-Care Plans.
Indemnity plans tend to offer a broader range of healthcare providers, but they usually don't pay until they receive the bill for care. This means that you will more than likely have to pay for all upfront costs out of pocket. It also means that you will often have to pay more than Managed-Care Plans being you have more availability of physicians.
Some points to watch out for with indemnity plans, however: They don't always cover preventative care (such as well visits), and sometimes these plans will require a deductible and co-pay. When shopping around, be sure to add these costs to your bottom line.
Managed-care plans can get complicated, so make sure you research these thoroughly. They tend to be on the cheaper side of individual healthcare plans, but you must understand all of the terms and provisions.
Some well known examples of managed-care plans are HMO, POS, and PPOs.
HMOs (Health Maintenance Organizations) typically lower the out of pocket cost, but your flexibility with finding a doctor is quite limited. You also must choose a primary care physician who can then refer you to a specialist if needed. You will only be covered for a doctor other than your PCP when a referral is granted. There are HMOs that will disregard the necessity of a PCP for a referral, but they tend to be more expensive.
POS (Point of Service) coverage offer more flexibility in managed-care plans as they allow members to choose medical services that are needed and also whether or not they will go to a provider within the network. They tend to be less restrictive than an HMO but cheaper than a PPO.
PPOs (Preferred Provider Organizations) use a network as well, but typically you not need to declare a PCP. Although these plans are more flexible than HMOs, then can be considerably higher after deductibles and co-pays.
Pre-Existing Plans: COBRA
If you leave a former employer, under COBRA you have 60 days to find another plan. If you choose to keep the plan you currently have, you will have to begin payment on your premiums at the same amount your former employer did with a possible 2% administrative fee. Sometimes, this scenario is best for people that have family members (or they themselves have), pre-existing conditions that would otherwise demand a much higher premium.
Getting to the Nitty-Gritty: What is a Cheap Plan?
I hate to break it to you, but health insurance premiums are filed and regulated with your State's Department of Insurance. This means that no matter what websites you peruse or agents you call, you'll pay the same amount for the same plan. Keep this in mind when shopping around.
There will be a few factors that determine what kind of premium you will receive: age, gender, location, and current health. All the quotes you receive online assume you are in generally good health, so if you aren't, expect to pay considerably more. Also be sure when comparing prices to compare one plan to its similar counterparty. For example, do not compare an HMO plan to a PPO plan premium - they are two different vehicles. Rather, compare HMOs to HMOs.
Even if you can't afford the Mercedes of health plans, be sure to purchase some kind of protection. God-forbid you get in a serious accident and need immediate medical attention... will you be able to pay your bills later?
The number one provider I would recommend is Blue Cross and Blue Shield. My parents belonged to this provider for many years, and they took care of me much longer after college than was necessary. They really were quite remarkable on what they offered for our family.
A great search tool that allows you to compare premium to premium is eHealthInsurance.com. Shopping for health insurance here is very similar to shopping for insurance on your vehicles.
Avoid the websites that appear extra gimmicky and unprofessional. Oftentimes when health insurance is advertised as incredibly and unbelievably cheap, chances are you will get a plan with so many provisions and restrictions that it makes the insurance seam almost completely a waste of money. You also don't want your information plastered all over the internet so that multiple cold callers can harass you for a few months.
Do as I did for Lily: research, research, research. If you are particularly time sensitive, get on the phone and call as many agents from reputable providers as possible. If you really just need to squeeze by with minimal coverage, try to do so from a provider who will actually "be there for you" despite you not dumping thousands of dollars into a premium.
Although healthcare in this country is not necessarily cheap, you can find some semblance of affordability to match at least your most basic of needs.
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You have provided some great information relative to health insurance. A few points that I have found to be important are as follows:
Even though the internet is a great place to research health insurance options, consumers really need to find a knowledgable independent insurance broker to explain both the positives and negatives of the plan choices. Far too often, people go for the lowest price without really knowing the pitfalls of the plan.
Health insurance is really all about doing the math. Consumers need to focus on the benefits they actually use and know how to reduce monthly premiums through risk assumption. A solid health insurance plan will have a coinsurance maximum which caps financial liability. By purchasing a higher deductible plan with a reasonable out of pocket maximum, one can significantly reduce premium cost. Newer HSA (health savings account) compatible plans allow the consumer to self-fund smaller medical expenses while maintaining important liability coverage for the "big stuff."
The bottom line from this chair is that there are many confusing plans in the marketplace, and the average consumer needs assistance in deciphering these plans. As with any business, there are good people who truly try and help the consumer through this health insurance "maze", and there are those who simply care about the sale. The best thing that today's consumer can do is work with a knowledgable professional who fully discloses the good, the bad, and the ugly of various health plans in an effort to help the consumer make the right choice.
John thank you so much for your informative and great post!
I agree with you that often one-on-one communication is geat - especially if you do find a caring professional. However, as I have actually worked on the sales end of health insurance plans, finding a good agent with your best intentions can sometimes be as tricky as finding an internet site that isn't attempting to trick you.
I also agree that oftentimes people go into what's "cheapest" without understanding what the plan really encompasses. It is really important to educate them on this information.
However, I have a few qualms with HSAs for people who really are looking for affordable health insurance. For one, they are often combined with high deductible health plans which can expose consumers to high out-of-pocket costs, which can affect their ability to pay. For the average consumer, they might be appropriate plans, but for people that are struggling - they might not be a huge benefit. Sometimes the rules about what HSAs can cover are so complex, as well, that it returns us to the problem of people not understanding what their plans cover.
So in essence, I agree with you that personal contact can help work out the kinks with all of these and explain the differences. Be absolutely sure, however, that you are working with somone who is really out to help you find a plan that matches your affordability AND need as best as possible, without aiming for their higher commissions.
Good hub. I have been in the insurance business for almost 30 years. I rarely come across posts or articles that I consider even a bit correct. I am managing general agent in health insurance. You have done a good job in addressing some issues that come up, such as affordable.
Affordable means very different things to different people. $50 a month might not be affordable to one persion and $1000 a month might be nothing to another. I still wonder what people really mean.
Health insurance is almost not insurance at least not in the pure sense. Insurance protects against a risk, not a certainty. Other than with health insurance, where would hear the comment from the insured "I can't wait to use it". The reason is that it comes from employee benefits for healthcare. When seen it that light it makes sense.
Interestingly, Blue Cross Blue Shield are not even companies. They fall under corporate law.
Health insurance is simply a way of financing health care. It is not the only way. The cost is related to cost of health care. A simple example would be to look at financing a $10,000 car and a $70,000 car. Would you expect to have the same payments? When it comes to health care and health insurance often all normal financial reasoning goes away.
Many people tend to see health insurance as way to pay $100 to get $30,000. I hear this everyday when someone who could have got health insurance but did not calls and says they are sick and need treatment. Now, that they are facing large healthcare bills that seriously feel that they should be able to pay a little bit and have some company pay all their bills. I guess that is what affordable means.
Thank you! My husband is unemployed and this gives me places to look.
Affordable Health Insurance is usually only found in certain plans which restrict the amount you can claim for.
If you are hospitalised or sick you also need to think about how you are going to pay all those monthly bills with some kind of Income Protection
Great overview of the different plans.
RUTHIE17 3 years ago
Good Hub with good information. Finding an affordable health insurance for yourself if a pain but does need to be done if you can afford it.
Remember, if you can't afford insurance there are ways to get health services at no to low cost for yourself and especially for your child. State, county and city agencies would be a place to start looking into this.
It's a shame in this great country of ours that people have to go without medical care until it's sometimes to late to be of help. Just another aspect of the haves and the have-nots!
Ruthie