When to Get Individual Health Insurance

If you are unemployed, self-employed, or decide to return to school you may want to buy an individual health insurance policy. Individual health insurance coverage serves to protect persons in times of health needs. Often individual health insurance is used when affordable group health insurance is not available. It is important to learn about the different types of health insurance offered by a company.

Fee-for-Service Insurance

How much is the monthly premium? What will your total cost be each year?

What does the policy cover? Does it cover prescription drugs, out-of-hospital care, or home care? Are there limits on the amount or the number of days the company will pay for these services.

Are you currently being treated for a medical condition that may not be covered under your new plan? Are there limitations or a waiting period involved in the coverage?

What is the deductible? Often, you can lower your monthly health insurance premium by buying a policy with a higher yearly deductible amount.

What is the coinsurance rate? What percent of your bills for allowable services will you have to pay?

What is the maximum you would pay out of pocket per year? How much would it cost you directly before the insurance company would pay everything else?

Is there a lifetime maximum cap the insurer will pay? The cap is an amount after which the insurance company won't pay anymore.

Health Maintenance Organization (HMO)

Are there many doctors to choose from? Do you select from a list of contract physicians or from the available staff of a group practice? Which doctors are accepting new patients? How hard is it to change doctors if you decide you want someone else? How are referrals to specialists handled?

Is it easy to get appointments? How far in advance must routine visits be scheduled? What arrangements does the HMO have for handling emergency care?

Does the HMO offer the services I want? What preventive services are provided? Are there limits on medical tests, surgery, mental health care, home care, or other support offered? What if you need a special service not provided by the HMO?

What is the service area of the HMO? Where are the facilities located in your community that serve HMO members? How convenient to your home and workplace are the doctors, hospitals, and emergency care centers that make up the HMO network? What happens if you or a family member are out of town and need medical treatment?

What will the HMO plan cost? What is the yearly total for monthly fees? In addition, are there co-payments for office visits, emergency care, prescribed drugs, or other services? How much?

Questions to Ask About a PPO

Are there many doctors to choose from? Who are the doctors in the PPO network? Where are they located? Which ones are accepting new patients? How are referrals to specialists handled?

What hospitals are available through the PPO? Where is the nearest hospital in the PPO network? What arrangements does the PPO have for handling emergency care?

What services are covered? What preventive services are offered? Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?

What will the PPO plan cost? How much is the premium? Is there a per-visit cost for seeing PPO doctors or other types of co-payments for services? What is the difference in cost between using doctors in the PPO network and those outside it? What is the deductible and coinsurance rate for care outside of the PPO? Is there a limit to the maximum you would pay out of pocket?