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Investigating individual health insurance | ||||
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Although selecting the right coverage is a matter of personal circumstances, careful research is essential to making a choice appropriate to your needs. All policies are not created equal, and the difference between good insurance and simply being insured can be significant. In some situations, you may be able to join a group plan, but many locum tenens physicians must look to an individual policy for coverage. If you are exploring this option for the first time, the abundant choices may seem overwhelming. However, with the right information, you can find the most affordable plan to suit all your healthcare needs. GETTING STARTED
Furthermore, individual plans are medically underwritten, so an insurer may have the right to reject your application or attach exclusions to your policy if you have pre-existing health conditions. This practice varies by state, however, so contact your state insurance department to learn more about your rights. A good resource is the National Association of Insurance Commissioners, at naic.org. You may also want to look at healthinsuranceinfo.net, where the Georgetown University Health Policy Institute offers state-specific consumer guides for getting and keeping health insurance. Once you are familiar with your state laws, take some time to shop around. You will be glad you did because prices differ so widely that premiums for similar products from different companies can vary by as much as 50% for the same person. Leave yourself a buffer—many states cut off pre-existing-condition coverage after you have been uninsured for 63 days. As a healthcare professional, you may already be familiar with the different options—HMOs, PPOs, POS plans, and traditional fee-for-service arrangements—but have you carefully assessed your own personal needs? One important consideration is whether or not you are willing to switch doctors. If you do not want to see someone new, you can immediately eliminate any HMO or PPO to which your preferred provider does not belong. Specialists are another important issue, since some plans limit both your visits and your choice of treatment. For example, if you plan to utilize an alternative practitioner or mental health provider, such as a chiropractor or a psychotherapist, find out whether the plan will cover these visits. Many plans place specific limitations on these types of services, and others do not cover them at all. If, however, you like everything else about the plan, you may decide to cover these costs out-of-pocket. In fact, personally covering these and other charges increases your options dramatically. You can lower your monthly premiums by as much as 40% by choosing a policy that has a comprehensive inpatient/outpatient plan with higher deductibles. This will cover any necessary hospitalizations, but you may be on your own for follow-up care. You can even take this one step further by choosing a policy that covers only catastrophic illnesses, as long as you are prepared to pay the bill for every routine office visit and lab test. COMPARISON SHOPPING Once you have evaluated your own personal priorities, there are several places to look for guidance. A good starting place is the Agency for Healthcare Research and Quality, at ahrq.gov. Here, consumers can compare several policies, including deductibles, co-payments, annual limits, and maximum out-of-pocket expenses. And at ncqa.org, the National Committee for Quality Assurance provides health plan report cards based on each plan's performance in five key areas, as well as overall accreditation ratings. More accreditation ratings are available from the Joint Commission on Accreditation of Healthcare Organizations, at jcaho.org. Another worthwhile online resource is ehealthinsurance.com, which is actually a licensed health insurance agency. Consumers can enter their zip codes and some basic information to receive free quotes and side-by-side comparisons of available policies. If you find a plan you like, you can apply directly online. Similarly, vimo.com offers visitors the chance to buy health insurance for themselves or their families, as well as for their small businesses. Touted as "the nation's first integrated comparison-shopping portal for healthcare products and services," the site provides access to side-by-side comparisons of health insurance plans, health savings accounts, physicians, dentists, and even surgical procedures. MyVimo, a personalization service, automatically updates users on changes in status of favorite healthcare professionals, accepted insurances, and more. Though e-shopping is becoming more popular, many people still prefer to contact their own independent insurance agent. If you do not have a representative, you can search for one by entering your zip code at nahu.org, the home of the National Association of Health Underwriters. And since independent agents must register with their state department of insurance, you can check there, as well. GROUP PLANS If you have difficulty finding an individual policy that suits your needs—or your pocketbook—you can try to qualify for a group plan. These plans typically offer more benefits for lower rates, but again, the rules for eligibility vary by state. Some states offer a "group of one" insurance policy, which means that a self-employed, sole proprietor can buy health insurance as a business if he or she meets certain requirements. Other states require that a business consists of at least one other partner or employee, which may still work for you if, say, your spouse helps to maintain your licenses and contracts. Even if you do not meet your state's requirements, you may be able to find a group plan through your alumni association, regional medical associations, state associations, chamber of commerce, or other affiliations to which you currently belong. Investigate potential group medical coverage through the American Medical Association as well. CHECKING THE FINE PRINT Regardless of the type of policy you choose, make sure you understand the details before signing on the dotted line. You should have a clear understanding of the financial aspects, including the exact amount of your monthly premiums, the deductibles you will have to meet, and any copays or percentage for which you will still be responsible. For example, if you choose a managed care plan, make sure you know how much—if anything—you will be reimbursed if you go out of network, how easy it is to change providers, and the referral procedures for seeing a specialist. Of course, if you plan to take locum tenens contracts away from home, make sure the policy provides coverage in those locations, and know the procedure for getting care and being reimbursed in an emergency situation. Also, if you have a pre-existing or chronic condition, find out how it will be handled, and double-check on coverage for any prescription medications you use. Another important detail: In many states, it is legal for an insurance company to cancel a health insurance policy because the insured person becomes sick. So look for a policy that is noncancellable and guaranteed to renew each year. If you cannot find that, the next best thing is a conditionally renewable policy, which means that the insurance company reserves the right to cancel all policies similar to yours but cannot single you out for cancellation. Finally, make sure the insurance company you choose offers a rescission period. Most companies will grant a full refund if you decide to cancel your policy within 10 days of joining. Selecting the perfect health insurance plan can be challenging, but by taking the time to fully examine your policy documents, you can rest assured that you have made an informed decision. Special thanks to Chris Arthurs, LUTCF, of Arthurs Insurance Agency, Inc., in Greenville, South Carolina, for his assistance in reviewing this article. REFERENCES About. (n.d.). Buying an individual health insurance policy. Retrieved January 24, 2006, from http://healthinsurance.about.com/od/individualpolicies/a/indpolicy.htm eHealthInsurance. (n.d.). What's the best health insurance plan for me? Retrieved January 23, 2006, from http://www.eHealthInsurance.com/ehi/NewHelpCenter.ds?entry=faqId=HI1;categoryId=HI1-12;entryId=1 Harrison, B. (2004, March 1). The ins and outs of health insurance. HT: The Magazine for Healthcare Professionals, 11(9), 68-70. Retrieved January 23, 2006, from http://www.healthcaretraveler.com/healthcaretraveler/content/contentDetail.jsp?id=88081 Insurance Information Institute. (n.d.). How do I pick a health plan? Retrieved January 25, 2006, from http://www.iii.org/individuals/health/health/howdoi/ Insure.com. (2004, June 7). Tips for buying individual health coverage. Retrieved January 25, 2006, from http://info.insure.com/health/individual.html Vimo.com. (n.d.). About Vimo. Retrieved November 25, 2006, from http://www.vimo.com/html/about.php |
