Individual Health Insurance Plans And Obamacare

| November 3, 2012 | 0 Comments

Individual Health Insurance Plans

Short Answer: A little more than 50% of the population in the US have health insurance through their employers. About 15 million people buy their own insurance. Buying your own health insurance can be a very daunting task. You should know which option will work best in your favor and it should be affordable as well. Individual health insurance plans in a nutshell are health insurance plans which you purchase on your own rather than being offered by a employer. The best way to search for such a health plan is to go to a insurance company’s website and look for their online tools to compare the plans and their related costs. The best way to keep the costs affordable and meet your coverage requirements is to follow some basic guidelines as we discuss below:

[dropshadowbox align=”center” effect=”lifted-both” width=”400px” height=”” background_color=”#ffffff” border_width=”1″ border_color=”#dddddd” ]TIP: Effective 2014, individual health insurance plans cannot deny or charge you higher premium if you have a pre-existing health condition. As of now, insurance companies can charge you a higher premium if you wish to purchase an individual health insurance plan for yourself or your child with a pre-existing condition.[/dropshadowbox]

Affordability Checklist For Individual Health Insurance Plan

Identify What Is Relevant To You: Nobody can predict, what will happen the very next moment when it comes to illness and injuries. However, there are certain medical treatments which we know will require attention in the near future like the on going preventive care, any specific health problem which you might have, like heart disease and also maternity coverage. Not all individual health insurance plans offer maternity coverage.

Don’t Get To Tempted To Buy: When it comes to our own self and family’s health insurance needs, we are driven by emotion and as a result instead of applying our mind and some logic we think through our heart. Honestly, even i did initially. This results in paying exorbitant amount for health plans. Analyse your financial budget and cross check your affordability before deciding on one particular health insurance option. One’s age plays a major role when it comes to reducing cost. Someone who is young and healthy, would choose an individual health insurance plan with a higher deductible amount (Out Of Pocket expense which you need to pay before the insurance company coverage kicks in). As a young person, paying high deductible amount can reduce your monthly premiums considerably and save you a lot of money in the long run.

[dropshadowbox align=”center” effect=”lifted-both” width=”400px” height=”” background_color=”#ffffff” border_width=”1″ border_color=”#dddddd” ]TIP: Effective January 1st 2013, under The affordable Health Care Act (Obamacare) special funding will be given to state Medicaid Programs choosing to provide low cost preventive care services to patients. Moreover, as all state Medicaid Programs as a result of this new funding from the federal government will have to pay 100% of Medicare Payment Rates to primary care physicians for primary care services. This will ensure proper and timely medical treatment for all.[/dropshadowbox]

Individual Health Insurance Plan

Check The Health Care Provider: Not all are comfortable in going to a new doctor as per the health insurance policy bought. Check with your long term serving family doctor if he is a part of the network which you have chosen through your individual health insurance plan.

Hoe Much Will You Be Paying: Always get a clarity on the amount which you will have to pay as a premium each month. There are a lot of hidden costs like coinsurance and co-payment which can add up to your expense every time you go for medical treatment. Knowing your expenses is vital here.

Patient Protection and Affordable Care Act (PPACA): This one is not so helpful right now but will affect individual health insurance plans costs drastically in 2014 and beyond. If your family income is less than 400% of the federal poverty line then you would be eligible for premium subsidies on individual health insurance plans. Premium subsidies are provided under PPCA for individuals purchasing individual health plans through health insurance exchanges. Please note, if you have a health plan through your employer then you are not eligible for these subsidies. For further details, you can refer this article: Individual Health Insurance Premium Subsidies In Exchanges.

Individual Health Insurance Plan

2014…. Change Is Coming……..

 

The Affordable Care Act Perspective For Individuals

  • According to the health care law, if you have a pre-existing condition and hence have not been able to obtain health insurance on your own or rejected by private insurance companies, you can get individual health insurance through Pre Existing Condition Health Insurance Plan.
  • I am sure you or someone in your knowledge has faced the dilemma of mis-selling and got deprived of health insurance benefits. If you feel that you were promised coverage for something which is denied by your insurance company then you have the right to appeal. More information can be accessed Here.
  • Effective 2014, if your family income is less than or equal to $88,000 for a four member family and your job does not provide you affordable health coverage then you can may be eligible for tax credits which will eventually help you to pay for individual health insurance plans.

How Does An Individual Health Insurance Plan Compare Against Group Plans

It is important to understand the differences between individual and group health plans as both have their own merits and disadvantages. Choose which suits you the best:

Individual Health Plans Group Health Plans
Individual health insurance plans can be purchased independently for self or family. Offered through specific groups like your employer, unions and communities.
The entire premium is paid by you. (You might get some tax benefits which is subjective) A part of the premium is paid by your employer making it more affordable. (You receive a tax benefits on the amount which your employer pays in your health premium coz it is not shown as your income)
Here there is no fear of loosing health insurance due to job. You continue to be covered till the time your are paying your premiums on time. The main drawback of group health plan is that they are dependent on your job. If you lose your job or become unemployed for whatever reason then your health coverage will also end. Although you have other alternatives to get health coverage when unemployed but they are expensive and temporary.
If you are young and healthy individual then it might be a good option to purchase individual health insurance plan with a higher deductible. This will reduce your premium. In group health health insurance you don’t have the option as the risk related to age factor is averaged out among the people who have health insurance within the group. So eventually you might end up paying more than your age would ask for.
Individual health plans are more tailor made health solutions and apt for customised medical needs. Group health insurance doesn’t come with that level of flexibility.
For high risk individuals, like having pre-existing health condition, individual health plans might not be a good option. If you are a high risk individual and at the same time have access to group health insurance then go for it.
Individual health insurance plans may also have waiting periods up to 9 months pre-existing conditions. Some group health plans have waiting period also known as affiliation periods. Check with your employer if their plan has one. Normally, waiting period cannot be more than 60 days.
Individual Health Insurance Plans & Pre Existing Conditions
In most states, you can be turned down for individual health insurance if your pre-existing medical condition is of serious nature (eg: HIV or Cancer). Having said that, you do have health insurance options like PPACA (Patient Protection and Affordable Care Act) provides a pre-existing condition health insurance plan for states which do not have their own health programs.
Image Courtesy: SS&SS and Tax Credits
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