Individual Medical Insurance

Individual Health Plans differ from the Group Health Plans often offered through employment. Most people today are much more familiar with group plans, and must therefore be very careful when purchasing an individual plan. Though there may be many ways in which an individual plan might differ from a group plan, several of those differences stand out. Generally speaking, individual plans do not cover maternity or pregnancy expenses. Most individual plans do not pay for routine checkups or exams. And most individual plans do not cover, or strictly limit coverage, for preexisting health conditions. These plans work well for those who understand the risk they are trying to avoid, as well as what is, and is not, covered under the individual plan being offered.

Preexisting Health Conditions are generally any conditions that you have been treated for, or received advice for, in the past 12 months prior to applying for coverage. In most cases, there will be no coverage for preexisting conditions during the first 12 months of coverage under the plan. Some carriers also put increased limitations on particular preexisting conditions. These are generalizations only. You should ask about preexisting provisions for each policy you are considering.

In some states, some carriers will out right decline to issue a policy if the applicant discloses certain conditions. The most serious conditions that can cause a denial of coverage include; diabetes, hypertension, cancer, mental or nervous disorders, drug or alcohol addictions, respiratory illnesses, circulatory illnesses, and heart disease. But there are many other conditions that may cause an individual to find it difficult to obtain coverage on an individual basis.

Deductibles seem to be a thing of the past since the HMO revolution. Most of us have gotten used to small copays for office visits or prescription drugs. Even hospital stays under an HMO plan only require a co-pay per admission of $100 to $500. With individual plans, in general, we need to get used to deductible all over again. It is these deductibles that contribute to a generally lower premium than that of a group HMO plan. Today some individual plans offer optional features such as an office visit rider which allows you to see your doctor in his or her office for a small co-pay of say $10, $15, or $25 and pick up a prescription at the pharmacy for $5 or $10 per script. The deductible comes into plan for all other services, such as MRIs, ambulance, or hospitalization. After the deductible, it is common to have a co-insurance agreement where the insurance company pays 80% of the next $5,000 in covered expenses, while you are responsible for the remaining 20%. After the calendar year deductible and co-insurance has been satisfied, the insurance company will pay the remainder of the approved expenses for the remainder of that year. The co-insurance percentages vary according to the plan you choose, as do the office visit co-pays and outpatient prescription coverage.

Supplemental Accident Coverage is offered on most plans. This benefit waives the deductible for injuries caused by an accidental event, if they are treated within 90 days of that accident. A typical benefit would be that the company will pay for the first $500 of expenses incurred due to the accident, before you are responsible to pay any deductible. Should the expenses go beyond that $500, you would then be liable to the agreed upon deductible and co-insurance.

Term Life Insurance is often market alongside individual health plans as an optional coverage. This is almost always a financially bad deal for the applicant. Your agent can always get you life insurance coverage for a better price as a stand alone policy. Besides, who want to end their life insurance policy when they switch from one health plan to another? Pass on the life.

HMOs do offer coverage in some rare situations. In Connecticut, for example, Blue Cross & Blue Shield offers an individual health plan that acts almost exactly like a group HMO. This type of opportunity comes and goes, state by state. And these plans are not for everyone.

The Bottom line is this, if you are healthy and wish to transfer the financial risk of the larger expenses while lowering you monthly health care premiums, an individual plan may suit you well. On the other hand, if you have small children or frequent your doctors office you may wish to purchase either the HMO type of plan, or get a job that offers group medical benefits.

Individual Medical Insurance Quote Request Form

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