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Basic Knowledge About Health Insurance for Individuals and Families

The changing healthcare and health insurance landscape in the United States has resulted in more individuals and families purchasing health insurance coverage on their own. Rather than touch on the number of reasons why this is the case, I would like to provide individuals and families finding themselves in this position with ten basic ideas to assist them with getting the best health insurance policy for their specific situation. Below is a combination of ten questions and suggestions that will provide the tools necessary to get a medical insurance policy that will best work for you and your family.

  1. What are your typical health and medical care expenses in a calendar year? Most people are surprised when they go through this exercise to learn that they would be financially better off in most years to purchase a high deductible health insurance plan and use the premium savings to directly offset heath care expenses throughout the year.
     
  2. How long do you anticipate needing the health insurance coverage? For example, many companies sell temporary policies that can be put in force for 1-6 months and they are relatively inexpensive. If you are in between jobs or in a waiting period for employer coverage, this may be your best option.

  3. What is your budget? If your budget is tight, having a $1000, $2500 or even $5000 deductible is better than having no coverage at all. The ability of doctors and hospitals to save and prolong life in the United States is in many cases extraordinary. However, their treatment is not free and going without health insurance coverage can in some cases result in you and/or your family losing an entire life’s worth of savings and assets.



  4. Be careful to choose a plan that covers the “big stuff”. It is nice to have a policy that covers items such as: physician office visits, routine physicals, outpatient testing, and blood work. However, it is essential to have coverage for major services such as cancer treatment, transplants, critical illness, traumatic accidents, and infectious diseases. Find out the lifetime maximum amount as well as if the policy contains “internal” dollar limits.

  5. Always carefully read and understand the pre-existing condition clause and policy exclusions so that you will not be surprised down the road if a claim is denied. This is important whether you are purchasing a standard medical, temporary, or student health insurance policy.

  6. Does the insurance company you are considering have a substantial network of preferred doctors and hospitals in your area? In addition to family doctors, what type of access will you have to specialists and the best hospitals in the event you or a family member is diagnosed with an illness that requires specialized care? Also, what are your options for preferred health care providers when traveling?

  7. If you need to go “out of network”, will you still have coverage? Most insurance policies will have coverage in the event you need to go outside of their network for care. However, review how these out of network claims will be paid. Will there be an additional deductible? How are reimbursement levels determined for out of network claims? What is your maximum out of pocket for out of network claims?

  8. Are you looking for an opportunity to reduce your taxable income? If so, make sure your plan qualifies as a high deductible health plan and look into all of the aspects of a Health Savings Account. In the right situation, HSAs can be an excellent way to pay for eligible health care expenses, reduce your taxable income and save for retirement.

  9. What are the financial ratings of the insurance company you are considering? A.M. Best, Standard & Poor’s, and Moody’s are organizations that rate the financial stability of insurance companies.

  10. What type of customer service will you get from your insurance agent? Do they specialize in health insurance? Do they have a staff that is willing and able to assist you in the event you have a claim, billing, or other customer service problem?
If you do not have the time or patience to look into all of the items mentioned above, develop a relationship with an independent insurance agent that specializes in evaluating and servicing health insurance policies. A good independent insurance agent will be able to save you time, money, and be an excellent resource for evaluating all of the items mentioned above.
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