Although many Americans rely on their employers for health insurance coverage, there are several circumstances in which private health insurance is a must. If the time has come to select your own insurance, read on for some tips to guide you in the process.
When You Might Need Private Health Insurance
Private health insurance is sometimes required if you are:
- A recent college graduate – Most college students are covered as dependents under a parent's health insurance plan or a plan offered or required by the university and sometimes they're covered under both. Grads lose their college insurance once they leave the alma mater, of course; and their dependent status when their age (usually 25 or 29, depending on the insurance plan) makes them ineligible to be covered by their parents' policy.
- Unemployed – If you lose your job because of downsizing or resignation, you are most likely eligible to continue with your employer's health insurance plan under COBRA, except that you will have to pay its full cost yourself – the employer won't subsidize part of the cost like it did when you were an employee. Eventually, this coverage runs out, and if you are still unemployed, you will need to find your own insurance. If you lose your job because you were fired rather than a victim of a downsizing, you are not eligible for COBRA and you'll need to find your own insurance right away.
- Part-time employee – Part–time jobs rarely offer health benefits. If you work part time, you usually have to supply your own health insurance.
- Self-employed – Unless you can be covered under a spouse or partner who is a W–2 employee, you have to provide your own health insurance if you work for yourself.
- Employer – If you start a business that has employees, laws might require that you offer them health insurance. Even if it is not required, you might want to offer it to be a competitive employer who can attract qualified job candidates. In this situation, you will have to shop for a business health insurance plan, also known as a group plan.
- Retired – When you retire, you are no longer eligible for employer-sponsored health insurance. You'll have to buy your own and because of your age and possible health conditions, it can be quite pricey.
- Dropped by your existing insurer – Sometimes people who need to make extensive use of their insurance, such as people who have serious medical problems, are dropped by their insurance companies even if they've been loyal customers for years. If this happens to you, consider seeking the guidance of an insurance agent who can help you find a plan specifically for someone with your medical condition.
Why You Still Need Health Insurance
If you find yourself in one of the above situations, don't go without coverage for even a day. A small emergency like a broken bone can ruin you financially if you're uninsured. These things are called "accidents" for a reason – in other words, you can't predict when they will occur. No one expects to get hit by a car while going for a walk or fall down the basement stairs when carrying the laundry, but these things happen and they can be expensive without health insurance.
If you think you can't afford your own insurance, you might be wrong. While there is a lot of hype in the media about the rising cost of healthcare, health insurance plans are available at a variety of prices. You might not be able to afford the kind of plan an employer would offer, but any plan is better than no plan. At a minimum, you want to be covered in the event of a major incident, such as the onset of a long-term illness or the aforementioned broken bone that sends you to a hospital.
First, decide whether you want (assuming you have a choice) a health maintenance organization (HMO), an exclusive provider organization plan (EPO) preferred provider organization (PPO), high-deductible health plan (HDHP), consumer-driven health plan (CHDP) or a point of service (POS) plan. Depending on your situation, a short-term plan might also be a good option.
After you've decided on a type of plan, you'll need to determine a deductible you are comfortable with. What could you afford to pay out-of-pocket each year in a worst-case scenario? Remember, the higher your deductible, the lower your premium; if your monthly cash flow is low, you might have to opt for a higher deductible.
Next, go to the website of each of the major health insurance companies in your area and examine the options for the deductible you've chosen. Plans available vary by state, and within your state, the premiums for each plan vary by zip code. Also, be aware that the plan price quoted on the website is the lowest available price for that plan and assumes that you are in excellent health. You won't know what you'll really pay per month until you apply and fork over your medical history.
Price and coverage can vary significantly by company. Often, it's difficult to make an apples-to-apples comparison to determine which company has the best combination of rates and coverage. Your best bet is to limit your options to reputable insurers, then choose the plan they offer that provides the best combination of features you'll use at a price you can afford. If you're choosing a family plan or an employer plan, you'll want to consider not just your own needs, but also the needs of others who will be covered under the plan.
Factors to Weigh in Choosing the Right Plan
Health insurance plans offer a variety of features. It's unlikely that you'll find a plan that offers everything you'd like, but consider the following features you need most so you can find the plan that offers the greatest number of them.
- Does the plan offer prescription drug coverage? Does it only cover generics? What is the co-payment (co–pay) on generics and on name-brand drugs?
- What is the office visit co-pay, and does the plan cap the number of office visits it will cover per year?
- What is the co-pay for professional services, such as x-rays, lab tests and surgery?
- What is the co-pay for a hospital stay? For an emergency room visit?
- Do you want a plan that allows you to add vision and dental coverage at minimal cost?
- Do you need pregnancy benefits?
- Do you already have a doctor you like? If so, you might want to find an EPO or PPO plan in which your doctor is part of the insurance company's provider network.
- What is the plan's lifetime maximum payout? Try to get the highest amount possible if you're buying a long-term plan.
- Does the plan offer discounted services for preventive care, such as a free annual check-up?
- Do you want specialty services like physical therapy, chiropractic and acupuncture visits to be covered?
- For PPOs, what is the cost for out-of-network services, should you want or need them? Can you afford this?
The Bottom Line
Getting your own health insurance policy isn't as easy or inexpensive as getting signed up with an employer's plan, but once you figure out what you need and become familiar with the terminology, it's not too intimidating. With the number of options available, you can probably find a plan that meets your needs – and your budget.