Many of us are fortunate to be covered for health care insurance by our employers; often, an employer will qualify for a favorable premium rate through group coverage, and will kick in at least part of the premium cost. Also, family members can be covered through an employee plan. In this ideal scenario, we hardly even notice the premium payments that are automatically deducted from our paychecks each month.
However, if we are not in this position — if we are self-employed, or unemployed, or otherwise find ourselves uninsured, then finding adequate health insurance coverage on our own can seem a daunting task. Going without insurance is unadvisable, even for the young and healthy — health care costs are astronomical, and a single accident or hospital stay can be financially devastating.
Insure Against a Catastrophic Event
So when you are shopping for individual or family health care insurance, make sure that any policy that you are considering will cover you against a catastrophic event. This generally will require a comprehensive policy. Your past health history is no indication of what may happen to you or a family member in the future: you have to be insured against any catastrophic possibility, whether a car accident or the onset of an illness requiring extensive hospital care.
Know Your Deductable Amount
When considering different policies, find out what your out-of-pocket maximum would be. This amount is the most you would be expected to pay toward medical treatment, beyond your premium costs; any costs beyond the out-of-pocket maximum will be covered by your insurance company. Any payment that you would be expected to make before reaching this maximum limit might be in the form of an annual deductible (an annual amount that you pay toward your medical bills before your insurance “kicks in”), coinsurance (a fixed percentage, often 20 percent, of any medical bill that you would be expected to pay), or copayments (a flat amount for a specific service that you would be expected to pay; copayments are usually very low, such as $10 for an office visit, and your insurance company will pick up the balance).
Pay particular attention to deductibles, as there are often separate deductibles for different kinds of services. Prescription drugs, for instance, may fall under a separate deductible for the year.
Understand the Limitations of a Policy
Determine any limitations your plan may have. Some plans may limit the number of times you may see a doctor in a given year, or there may be limitations on the kinds of medications covered. Try to avoid any plans that put a cap on prescription drug coverage, and don’t accept daily limits or caps on hospital or other charges. A “discount health plan” may limit miscellaneous hospital charges, for instance, to $20,000 per hospital stay, but if these charges end up being $32,000 — and they may well be, for lengthy stays! — then you’re stuck for the additional $12,000, on top of deductible and coinsurance.
Preexisting conditions may present additional difficulties. Generally, if you have a preexisting condition, a health insurance company will put a rider on such conditions, refusing coverage under some circumstances. It may be possible to work out an arrangement with your prospective insurer in which you pay an extra monthly premium (which may be nominal) for coverage without riders. See what you can arrange.
Beware of Discounted Health Plans
Many health insurance companies lure customers by selling discount health plans, which may be inexpensive but which are sure to have major gaps in coverage. If the insurance salesman is pressuring you, refuses to give quotations or detailed information over the phone, or tries to get you to write a check during your first meeting, then look elsewhere. Try to stick with a major insurance company. Blue Cross and Blue Shield (which has subsidiaries in each state), Aetna, Cigna, and others are all long-standing companies that offer comprehensive policies, and that don’t need to resort to high-pressure tactics to sell policies.
Short-Term Health Insurance
If you are between jobs but cannot continue your coverage under your previous employer’s plan while you’re looking for work, you might look for short-term health insurance, or temporary health insurance. Such short-term policies usually last from as short at time as one month up to a year, and sometimes can be renewable. They often don’t cover routine care such as check-ups and other preventative procedures, but should cover you for all emergencies, hospital stays, prescription medication, and even home care; a short-term policy should also cover your family. Such coverage can be quite affordable, but should not be considered a substitute for a full-time comprehensive health care policy.
Looking for affordable health insurance can be intimidating at first, but, with proper research and comparison shopping, you should be able to find a policy that suits your needs. The most important thing is to ensure that you and your family are covered by at least a temporary policy at all times.