Personal
Health Care Insurance: Explore All
Your Options
Coverage is available
Personal health insurance is available in many variations; while
good coverage will probably not be quite as cheap as group coverage,
you still should be able to find something affordable that will
protect you from the extreme costs of having no coverage at all.
Federal laws
protect those who have had group coverage
If you have had group coverage for the past 63 days, you are entitled
under a federal act—referred to simply as COBRA—to keep
your group coverage and pay it yourself for up to 18 months. This
period is extended to 3 years if you are disabled. Be prepared for
a much higher cost than you are accustomed to, however, as your
employer will no longer be sharing the premium with you.
Another federal act referred
to as HIPPA says that no company can turn you down, regardless of
your health if you have not been without group coverage for more
than 63 days. HIPPA does not, however, control the premium for the
coverage. If a company doesn't want to cover you, they can simply
charge you a premium you can't possibly afford.
Coverage varies
according to the plan a company offers
Under group coverage, you may have had few choices, and therefore
may not be aware of the many variations of coverage. Generally speaking,
you have indemnity plans—also called "fee for service," and
managed care plans called HMOs. The indemnity plan is traditional
insurance. You go to a doctor of your choice; he charges a fee for
his service and you pay a part of it, called a co-pay. The insurance
pays the remainder according to a schedule of "usual and customary"
rates which vary from place to place.
The opposite of the fee for service is the HMO. In this type of
plan, you have a primary care doctor and cannot see any other doctor
without a referral from the primary provider. Many people do not
like the restrictions of the HMO, but these plans are usually more
affordable than traditional coverage. They do not, however, guarantee
any better coverage than a traditional plan.
A third type of plan
that blends traditional insurance with the HMO is the PPO, or Preferred
Provider Organization. In these plans, you can see any doctor in
the network without a referral from a primary care physician. You
can also go outside the network, but will pay a higher copay, and
you may even have a separate deductible.
Finally, there are some catastrophic coverage plans that do not
pay for doctor visits at all, but only pay if you are admitted to
a hospital. Some plans which are not considered "catastrophic" simply
have such a high deductible that you are not likely to use the insurance
unless you do have an accident or major illness. These plans will
usually be a cheap alternative.
Finding the best
plan for yourself
Unfortunately there is no standard personal health insurance plan;
the only way to find the one that is right for you is to consider
your current health, the risks you are able and willing to take,
and look for a plan that will provide health coverage at a price
you are willing to pay. Usually, a knowledgeable agent can help
you understand the terms of any company policy.
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