Brian Gruss Licensed Insurance Planner

Know What to Look for When Buying Individual Health Insurance

Most Americans who have health insurance are covered through an employer’s plan. However, some employers do not offer health insurance coverage. If you work for one of these companies, you will need to purchase private individual health insurance.

There are certain advantages to purchasing health coverage in the private market. Instead of choosing from plans pre-selected by an employer, you decide which plan features you want, and pick a plan accordingly. For example, by choosing a plan with a higher deductible, or one that doesn’t cover certain services, you may realize a substantial premium savings each month.

Instead of having your coverage tied to a place of employment, coverage through a private health plan is yours to keep no matter where you work. A health insurer can’t drop you as long as you pay your premiums on time.

But along with these advantages come some potential disadvantages-

• Employer plans provide considerably more coverage than individual plans, even when you are paying the same premium rate. That’s because with an individual policy, a larger percentage of the premium goes to pay for such operational costs as marketing and paying claims.

• A group plan generally must insure all employees and family members, while individual plans can reject applicants who aren’t in perfect health. They can also offer plans that exclude coverage for certain pre-existing conditions.

• In most states, private health insurance plan premiums increase as you age. Initially, you can avoid these rate increases by periodically changing plans, because new rates tend to be lower than renewals. However, as you get older, it will become more difficult to find a company to insure you and individual policies will get more expensive.

If you do need to shop in the private health insurance market, you first need to find a competent insurance agent.  Determining what kind of insurance you need and how much coverage to buy are complex issues. A good agent will help you assess your situation, and work with you to find the right coverage for your specific needs. The key to a successful working relationship with an insurance agent is trust. You should be able to trust your agent’s knowledge, experience and professional judgment, and you should always feel secure that your agent is acting in your best interest. But keep in mind that trust is a two-way street: Your agent also needs to trust you to provide information that is truthful and complete.

If you are comparing several plans, you need to know what to look for before making a decision. When choosing a health plan ask your health insurance agent the following questions:

·   Will the plan cover me for the specific doctor or hospital I would like to use?

·   How does the referral system work?

·   What pre-existing conditions would affect coverage?

·   How will the plan handle care if I (or a family member) am away from home?

·   What is the plan’s monthly premium, and what deductible and coinsurance am I required to pay?

·   Are there other fees, such as copayments and any additional charges if I use providers that are out-of-network?

·   Is there a maximum amount the plan will pay over a year or a lifetime?

·   What types of benefits are specific to this plan?

The purchase of individual health insurance in the private market can seem confusing. Approach its purchase like you would that of any important item-research your options and compare prices, and get the best advice and assistance you can, in this case, the services of Brian Gruss a qualified insurance agent.

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Can You Lower Your Individual Health Insurance Costs?

Everyone is searching for ways to save money in these difficult economic times.  None of these efforts is more intense than with health insurance.

Consider this example: an employee that has been advised that his premium for dependent coverage will be increasing to more than $1,000 per month! After absorbing this bad news, he looks for some way to lower that cost. After significant research, he discovers that he can get individual coverage for his wife and two children for $350 per month. But should he make the change?

The answer is not always clear cut.  If he can obtain “similar” coverage without pre-existing conditions, a comparable network, and the insurer is a highly rated carrier with a stable history, the answer is probably yes.  The key is whether or not a person can find truly similar coverage and still achieve cost savings.

Historically, true group plans tend to offer more generous benefits than individual plans. For instance, certain benefits (such as maternity) may only be available through group plans in certain states.  Prescription drugs may be covered without spending limits.  Also, in general, group plans offer guaranteed issue coverage for all employees regardless of health status.  Insurers offering individual coverage can decline to issue coverage entirely or exclude coverage for certain conditions indefinitely for any applicant.

Below are some questions to ask yourself before purchasing an individual health policy to replace group coverage for you and/or your dependents:

1. Will you or your spouse need maternity benefits in either the near or distant future?
2. Have you carefully compared premiums?  Remember that most premiums for dependent coverage under a group plan are paid pre-tax.  Individual policies you purchase on your own will be paid post-tax, unless you are able to deduct healthcare premiums as a miscellaneous expense.
3. What are the overall limits of coverage for the individual policy you are considering?
4. With the new plan, are your doctors and hospitals in network?
5. Have you researched the insurance company’s track record for raising rates each year?
6. How will the application for insurance be underwritten?
7. Are you willing to make the trade-off of accepting a plan with less comprehensive coverage for a lower rate?

If you are currently enrolled in a group health insurance plan, it’s entirely possible that you may not be able to find a better bargain.  Be aware that even if you switch to an individual plan, your premiums more than likely will still increase annually, and possibly even more so than under a group plan.

Remember that it is critical to understand what you are buying with any insurance purchase. At any rate, if you do decide to purchase an individual policy, DO NOT drop your current coverage until you are approved and have thoroughly reviewed your new policy.

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Brian Gruss is now representing Premera Blue Cross and Blue Shield of Alaska.  What that means to you, is now I can help you out with your Alaska Health insurance needs, whether they are Medicare Supplements, or Individual Health Insurance, or Group Health Insurance.

Tags: Alaska Health, Alaska Insurance, Blue Cross And Blue Shield, Group Health Insurance, Gruss, Health Insurance, Individual Health Insurance, Insurance, Medicare, Medicare Supplements