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Index | Health Insurance | Individual Health Insurance

Individual Health Insurance

"Individual Health Insurance" is a term used to describe the health insurance that is not connected to a business and is not a part of a Group Health plan. This is the insurance some people have to purchase themselves, and not through their employer or organization. Usually those who do not have access to Group Health coverage sponsored by employer (people who are self-employed, leave their job or start another job that does not provide adequate health insurance, or those who run out of COBRA benefits) and do not qualify for public programs, have to buy Individual Health Insurance coverage.

Individual policies are more expensive and sometimes people with chronic or serious conditions may experience difficulties trying to enroll. You might have to undergo a medical exam to prove that you are insurable. With Individual Health Insurance you often get fewer benefits than with Group Insurance.

Individual Health plans are medically underwritten, which means that insurers make decisions whether to take a person on the policy or not, what premiums to charge, what benefits to provide and what exclusions to attach. Insurance companies rely on a person's health condition, age, gender, their medical history and other criteria in their decision. In case you have serious health problems, like diabetes, some insurers may deny your application.

With Individual Health Insurance, premium costs are likely to be rather high. The rates will be substantially higher for senior individuals and those who suffer serious conditions. Determine how much you can afford to spend on Individual Health Insurance and then shop around to compare health insurance policies and find the best price among a number of insurers most suitable for you and your family.

Since the rules and regulations of Individual Health Insurance considerably depend on the state of your residence, it is important to know well what your rights are. You are recommended to contact your state insurance department to clarify what you can expect.

In some states, medical underwriting is illegal and insurers cannot reject applicants due to their health condition or charge higher premiums. Other states arrange a designation of one or several insurance companies as "insurers of last resort." Such companies guarantee issue coverage. In a number of states only those residents who have a continuous coverage history can purchase Individual Health insurance on a guaranteed issue basis.

If all other attempts at getting health insurance haven't worked out, one can apply to high-risk pools as the last option, public programs covering "uninsurable" people who were rejected by private insurers. Usually it is a chance to purchase health insurance for people who have been refused coverage by one or more insurance companies due to their health problems. In order to find out if your state has a high-risk pool program, contact your state insurance department.

Health Insurance is a necessary investment and going without it is unwise and risky. In case you or your family experiences some serious injury or illness, in addition to health problems, you might face financial troubles. However, before you decide to purchase Individual Health Insurance, try other options which might be not as costly.

For example, you can ask your insurance company to convert their Group policy to an Individual policy. If you are married, it can be a good idea to join your spouse's Group Health plan. Another option is to join a Group Health plan through a professional or trade association in order to get more reasonable quotes. If you are over 50, you can join extensive health plan of the American Association of Retired Persons (AARP).

Purchasing COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) from your former employer may be a good option. You have a chance to keep on your health insurance coverage for up to 18 months after you leave a job. You have 60 days to decide whether you are willing to enroll in COBRA. Meanwhile you should be looking for a suitable Individual Health Insurance policy. Within those 60 days you will find out if you are accepted. COBRA provides coverage for all members of your family, which is very convenient. In case you purchase an individual policy that does not cover your spouse due to their pre-existing illness, COBRA can still work for your spouse only.

With Individual Health Insurance, it is important to find the right coverage at a reasonable price, which can be a difficult task. You can apply to an independent agent to help you find the best policy for you and your family. Your budget, health requirements and doctor preferences should be taken into consideration when choosing the most suitable plan for your needs.

Generally, the individual health market offers the same options as the group health market, and you can choose between Fee-for-Service Insurance, Managed Care Plans, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), or Point-of-Service (POS) Plans, Open Enrollment in Managed Care Plans, Association-Based Health Insurance and High-Risk Pools.

Open Enrollment in Managed Care Plans

In some states, Managed Care plans are required to have an "open enrollment" period annually. It is usually a one-month period during which people with medical problems can join Managed Care plan without medical exams. Such an option is available in other types of health insurance as well. In order to learn the rules in your state, contact your state insurance department.

Association-Based Health Insurance

Members of some professional, community and religious organizations can enjoy an opportunity to get health insurance coverage at group rates. However, it is important to clarify whether the coverage offered is complete, which medical expenses it will cover and what it will cost you on a monthly basis, and whether it will offer coverage to your family members too.

In case you cannot make up your mind as to what health insurance plan fits your needs best, you can opt to apply to an independent health insurance broker. Make sure the broker will work in your best interest and offer you the most suitable insurance product.