Health  Short Term  Supplemental  Dental  Travel  Life  Long Term Care  Annuities  Student  Disability

individual health insurance plans
affordable individual health insurance
Individual Health Insurance Quotes

Buying Individual Health Insurance

If employer sponsored health insurance is not available, or it is too expensive to add on dependents, or is not adequate, you may be able to buy it as an individual for yourself and/or family depending on a few factors.

The plan type that most people buy is a plan with PPO claims convenience. In most states, most plans offered to individuals have a PPO structure. In some areas there may be an HMO available, but many areas have no HMO plans at all for individuals to buy, and EPO and indemnity are not popular. So the choice is mostly between PPO plans because of their flexibility and convenience.

A summary of the different plan types is given below and in the glossary. As stated above, not all may be available in any given state or region of a state. The two basic types are pre-paid and fee-for-service. An HMO is pre-paid. Fee-for-service types include simple indemnity, PPO, and EPO. Pre-paid may be an arrangement with independent providers or with a specific group or clinic of doctors.

Compare the options carefully because there can be significant coverage and premium differences between companies but they also can be very similar in value. Buying as an individual/family may not cover as many categories as group health coverage, e.g., maternity, rehabilitation programs, mental health coverage, and substance abuse treatment.

Indemnity Health Insurance:
This is the simplest and least cost-effective arrangement. The insurance company pays the fee for the insured's medical treatment, with no prior agreement between the health insurance company and the medical provider. Consequently, there is complete freedom to choose doctors and hospitals and other health providers across the nation. Change providers at any time. Go to any hospital or physician anywhere in the country.

This type of coverage is like most other categories of insurance, e.g., auto insurance or home insurance. When damage occurs, the expenses are paid by the insurance to whoever repairs or replaces what is damaged or lost. However, with maximum freedom comes maximum cost. The health insurance company is confronted by charges that may be excessive because "insurance is paying for it". The more the health insurance company pays for services, the higher the monthly premium you will be charged.

Health Insurance for Individuals

The health insurance company may try to negotiate what it believes to be an excessive charge. This results in more cost and delay. There may be no agreement reached. You may be expected to pay the difference. There is more paperwork because there is no pre-agreed electronic claims protocol. The process is inefficient and this type of coverage is consequently the most expensive.

Because PPO plans have in and out-of-network coverage, they include indemnity coverage in addition to the advantages of network availability. Since PPO premiums cost less than indemnity plans, there is no advantage to an indemnity plan.

Preferred Provider Organization (PPO):
The preferred provider organization is an arrangement between the claims payer and the medical provider to facilitate claims payment. There are codes for each medical service and a pre-agreed payment for each service. This enables efficient electronic claims processing and no need for negotiation over what is a reasonable fee for the service performed. Insureds may go directly to specialists so unlike some HMO's, there is no primary care doctor and no referrals to specialists necessary. This arrangement is called a "network". Out-of-network care is still covered, but copays are usually not available and the deductible and coinsurance is higher than in-network. Most insurance plans for individuals to buy has a PPO claims system.

Health Maintenance Organization (HMO):
A Health Maintenance Organization signifies a "pre-paid" or "capitated" insurance plan in which the provider is paid a fixed monthly fee for possible future services if needed, instead of an individual charge for each incident of medical service. The monthly payment to the provider remain the same, regardless of how much or what services are provided. The physicians are employed by, or under contract with, the HMO organization which may be a special administrative entity or an insurance company. This form is generally more popular with employer health insurance.

Point-of-Service (POS):
Point-of_Service plans combine an HMO with pure indemnity health insurance. The insured can choose either to go to an HMO provider or to any physician or hospital or other medical provider in the nation. There is higher out-of-pocket expense to the insured if the choice is made to go outside the HMO network. The monthly premium is typically higher for a POS plan than an HMO plan with similar HMO benefits.

Health Savings Account (HSA):
Health Savings Accounts (HSA's) are actually bank accounts, not insurance plans. The right type of coverage qualifies the insured under the tax code to be entitled to open a health savings account. Contributions to the health savings account are tax deductible. So the individual health insurance plan is a "qualifying" or "qualified" plan, i.e., it qualifies under the tax code to allow the opening of the bank account. Payment for medical and other expenses can be made out of the account, if desired. However, the tax deduction is for contributions, not for expenses paid out.

affordable individual health insurance Health Insurance Quotes and Insurance Brochure