What can I expect now that I need Individual
health insurance coverage?

People who need personal health care insurance often experience a bit of panic, so we may as well acknowledge from the start that it is likely that the premiums will not be as cheap as what you were used to under your group plan. That's because you will be paying the entire premium rather than sharing it with your employer. In other respects, you will have more choices since you can choose the type of deductible you want, whether you want traditional insurance or an HMO, and whether you want added riders such as vision and dental care.
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Can I pay my small medical expenses myself, and just buy a policy for major medical emergencies?
Yes. Many self employed choose a policy with a high deductible and that does not pay for things like office visits. They put money into a savings plan—called a Health Saving Account (HSA)—which money is then deducted from their annual income. They can then withdraw from the plan—tax free—to pay for things like office calls, medication, vision, and routine dental. If they ever do have a hospital bill, the plan kicks in as soon as that high deductible has been met.
In addition to a major medical with a high deductible, you can purchase indemnity plans such as cancer insurance, critical care insurance, and hospital indemnities. These plans pay you back in addition to whatever your insurance pays, giving you money to pay costs your insurance might not have covered.

How can I tell what expenses my insurance company will pay?
Your agent will be able to give you the most important details before purchasing the policy. With health insurance, many companies allow you to examine the policy before sending in the first payment. You will get detailed descriptions about the benefits as well as the exclusions. Be sure to ask questions about anything that isn't clear.

I have diabetes. Can I still get a health insurance policy?
Maybe. If you are only taking medication by mouth, most companies will insure you. If you are taking insulin, it may be more difficult, and you may have a higher rate. Companies that sell private health insurance have different underwriting rules. Some will turn you down for major illnesses while others may give you an exclusion for anything relating to that illness or may simply give you a higher rate.

If I get a major illness or injury, does my health insurance have the right to cancel my policy?
No. Companies are regulated by insurance laws which have changed greatly over the years. Nearly all policies have to be guaranteed renewable, meaning the company cannot terminate the policy just because you use it. They can, however, increase your premium.

Do health insurance companies charge everybody the same amounts for the same coverage?
No. In a group plan, the price is based on the average age and insurance usage of all groups of the same type. In an individual plan, the company takes into account your own history, your age, whether you smoke or not, and whether you have a healthy life style, a dangerous job, and so forth.

What is meant by in or out of "network"?
Network is not as much of an issue today as it once was although it can be important if you choose an HMO. In a networking plan, doctors have contracts with the insurance company to accept an agreed upon amount. If you do not go to a doctor who is on the list you will have to pay more. If you are in a traditional plan—a private fee for service plan—you can go to any doctor who agrees to file the insurance and accept the payment. The doctor himself does not need a contract. You will find some doctors who do not participate in any kind of insurance, but make you pay the bill yourself and file your insurance on your own. These doctors would be considered "out of network"; your policy may give you separate deductibles and copays for such a doctor.

How can I find an individual health insurance policy?
You want a policy from a stable company that has been in business for a long time and is known for paying claims promptly. The accounting department of your local hospital may be willing to tell you what companies they like the best and what ones to avoid. You will have to ask in person as this information is not usually given out over the phone. You want reasonable rates with coverage you can depend on. It is also a good idea to review the policy with your insurance agent. Start here to receive information from qualified agents from some of the best companies in the country.
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