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Individual Health Insurance: Knowing What You’re Getting and Figuring Out What You Need

While most Americans with health insurance are covered under an employer's plan, there are still many employers that don't have health insurance offerings. Workers of companies not offering insurance are left to find and purchase their own private individual health insurance directly from an insurer.

There are actually several advantages to purchasing private individual health insurance:

Unlike those covered under an employer's plan, you won't just have a limited number of plans that were pre-selected by someone else to choose from. You, instead of your employer, get to determine what plan features are desirable and pick the plan that you see fit. By having a variety of plans available to you, such as those that don't cover services you don't want and that have higher deductibles, you can take advantage of lower premiums.

Since private health plans are under your control, not your employer's control, you also won't have to worry about losing your coverage if you ever want to change jobs. As long as you pay your premiums when they're due, the coverage is yours to keep and the insurer can't drop you.

However, there are also several disadvantages to private health plan coverage, for example:

Even if paying the same premium rates, individual plans usually provide less coverage than employer plans because individual policies have a larger percentage of the premium dollars going toward paying operational costs.

The premiums for private health insurance plans increase as you age in most states. Since renewal rates tend to be higher than new policy rates, you can avoid the rate hikes for awhile by changing plans as rates become higher. However, this isn't a long-term solution. Eventually, your age will make it more difficult to find an insurer and your individual policy will become more expensive.

Group plans are typically required to insure all employees and their family members. On the other hand, if an applicant of an individual plan doesn't have an ideal health status, then the insurer can reject the applicant.

If you do decide to go with private health insurance, then you'll need to make sure that you work with the right insurance agent. Figuring out what type and what amount of insurance best meets your specific needs can be an overwhelming and confusing process. Having the right agent to help you assess your situation and apprise you of your options can be invaluable during the process. Being able to trust in your agent's expertise and professional judgment and trusting that he/she will be working in your best interest are the keys to having a successful working relationship. Do remember that the agent also needs to be able to trust in you. So always make sure that any information you provide to your agent is honest and not withholding.

You will also want to keep a few questions in mind to ask your agent as you compare plans:

  • What are the plan's monthly premiums, coinsurance, and deductibles?
  • What benefits does the plan offer?
  • What pre-existing conditions affect my coverage?
  • Is the doctor or hospital I want to use covered under the plan?
  • If I use out-of-network providers, will there be additional fees or charges?
  • How does the referral system operate?
  • How is care handled should I need medical services when I'm away from home?
  • Does the plan have a maximum amount it will pay over my lifetime or per year?

In closing, purchasing private market insurance isn't as complicated as it might seem, but getting the right policy will take a little effort on your part. Remember to approach it just as you would any other major purchase - research all your options, do price and benefit comparisons, and seek expert advice and assistance.