Pick The Health Insurance Plan That's Right For You

For many people, group health insurance is not an option because not all companies can or do offer group health benefits. For many others who have left jobs for whatever reason, COBRA is too expensive, even though coverage is usually comprehensive.

Increasingly, people are turning to individual health insurance for its flexibility and versatility. You can tailor a plan to meet your needs at any stage of life -- from basic plans for the young and healthy that cover major medical expenses to comprehensive plans for growing families that cover routine doctor's office visits and prescription medicines.

You can find the best fit for your insurance needs by comparing individual medical plans in these categories:
• Availability - what insurance plans are available in your state? States regulate the types of plans that are offered by insurance companies and the coverage those plans provide.
• Coverage and benefits - what health services do you want to have covered, and which insurers offer those benefits? How much will the policy pay for those services, and what is not covered?
• Access - if you have a preferred doctor or health care provider, which insurers give you access to them? What steps do you need to take to see your preferred doctor, or where else could you go for service to be covered by insurance?
• Costs - how much are the monthly premiums? How much will you have to pay out of your own pocket for deductibles, co-pays and co-insurance? Does the insurance offer discounts for using certain doctors? If so, how much is that discount worth?
• Exclusions and limitations - if you already have serious or long-standing health problems, what rules are there about excluding pre-existing conditions or limits on total benefits a policy will pay?

Choosing the right individual medical insurance takes effort. Investigating your options takes time. So does ongoing management of the health care process, from the time you apply for coverage to the use of health care services to the claims process for reimbursement. But "ongoing management" doesn't have to be intimidating. Once you understand what's available, you can quickly match your needs and wants with an individual insurance plan that's a good fit.

Questions to consider as you start evaluating options:

1. Do you want comprehensive coverage that pays for doctor's office visits and prescription drugs? If so, you'll likely pay a higher premium for these "premium" services.
2. Can you pay for more of your own "routine" health care services and rely on insurance to cover major medical expenses such as ER visits, hospital stays and serious illnesses? If so, your premiums may be lower than you expect, but you'll have to spend more time planning and preparing financially to pay for things like doctor's office visits and prescription drugs.
3. Are monthly premium costs and out-of-pocket expenses such as deductibles and co-pays extremely important to you? If so, keep in mind that these expenses are driven by coverage options you choose. Plans with more coverage and low deductibles cost more; plans with less coverage and high deductibles are less expensive. And for most people, paying directly for office visits will lower the monthly premiums enough to "break even" in 8 to 12 months.

Robert Johnson is the President of Consumers for Competitive Choice, Inc. (C4CC). C4CC is a diverse national coalition of Americans who support a strong, vibrant and consumer-focused economy. C4CC publishes Simple Coverage. Simple Coverage offers information and resources about individual health insurance.