Thursday, March 24, 2011

How to choose an individual health insurance plan:

When shopping for an individual health insurance policy, check with an agent who represents several health insurance carriers and ask for a price comparison. It pays to do your homework.

Can I be covered for pre-existing conditions if I purchase a policy? 
In most cases, If you have been insured with no more than a 63 day lapse in coverage, then you will have coverage for pre-existing conditions. If you have been uninsured for a longer period, then it is likely that your pre-existing conditions would be excluded for at least 12 months.

Do I want to keep my doctor? If you have a particular physician you like, you will want to make sure that he or she is a preferred provider to get the maximum benefit from the coverage.

What is my current and anticipated health care need? 
Consider the services you and your family will need on a regular basis. If you or a family member is prescribed medication on a regular basis, you will want to discuss that with the agent.

What will my out-of-pocket expenses and monthly premiums cost? 
Does it make sense for me to pay a premium for lower out-of-pocket costs? 

Does the plan cover prescriptions and X-rays? 
Prescriptions are one of the most used benefits of health plans. Review the coverage of any health plan to determine if your current prescriptions are covered and at what level. X-rays are a routine part of some treatments, so it's wise to make sure X-rays are covered in each plan you consider.

Do I prefer certain specialists? 
Some plans limit not only your visits but also who you can see and what is covered. If you want to see a naturopath or chiropractor, be sure to ask your insurance agent about coverage for these services. Similarly, prosthetics, orthotics, psychotherapy and many other rehab services may likely have specific limitations as well. Be sure to inquire about insurance caps on services/specialties you may use. Sometimes you may have coverage, but the services may have a low yearly or lifetime cap on billed charges.

What do I look for if I can't afford a policy that covers routine care? 
Look for comprehensive plans with higher deductibles rather than cutting back on coverage. A basic hospital/surgical plan might cost less, but if you end up in the hospital, the last thing you need to add to your list of worries is how you're going to pay for follow-up care once you're released.

What will it cost me for emergency care? 
Look at what costs, including co-pays or co-insurance, or services such as hospital and surgery care, apply towards the deductible.

What are some of the improvements as a result of the National Health Care legislation? 
One example is more coverage availability for some preventive healthcare. For those defined as preventive, there are no deductibles, coinsurance or copayment.


Stephanie Owen Nelson is the owner of Pacific Crest Insurance in Coeur d'Alene, Idaho

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