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Individual Health Insurance

We’ve all been there – some minor medical issues pops up and you go to look for a specialist in your area, only to find that your Individual Health Insurance is out of network, or you open the mail to find a bill from an ER visit that is way higher than you expected because your deductible hadn’t been met. Finding the right health insurance plan that’s affordable can be challenging. Navigating the ins-and-outs of what’s covered, who’s in network, and what you’ll need to cover out-of-pocket is tricky – Ansay & Associates can be your guide to finding the coverage that’s right for you.

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All shapes and sizes

Typical insurance policies will cover the same basic benefits – a visit to your general practitioner, emergency medicine, labs and imaging, and specialist care – but what you pay and what your health insurance picks up will vary depending on a lot of factors. In the end, you have to find a plan that meets your needs at an affordable price. Some key features that can affect your premium payment and the health insurance payout include:

 

Deductibles

This policy feature can have one of the biggest impacts on your premium price. Essentially, the deductible is what you pay before your individual health insurance plan kicks in.

 

Networks

Each insurance company works in specific “networks” of providers, before selecting an individual health insurance plan, review the in-network and out-of-network providers to see if your care team makes the cut. If not, you may end up paying extra for every visit.

 

Copays vs. Coinsurance

Copays are a flat fee you pay your provider or the care facility prior to an appointment. Copays can vary depending on the care you are receiving (specialist copays tend to be slightly higher than your GP). Coinsurance is a percentage of the cost of your visit up to a certain dollar amount – 80/20 is a common coinsurance rate, where you pay 20% of the visit cost and your insurance pays the remaining 80%.(after your deductible is met of course).

 

Maximum Out of Pocket

Another determining factor in how affordable your individual health insurance will be, is the maximum out of pocket. This is the most you will pay out in a given year before your insurance starts picking up 100% of the cost of care. This maximum is almost always well beyond your deductible.

Main Types of Health Insurance

Now that we have looked at some of the price-affecting features of health insurance plans for individuals, it might be helpful to look at the main types of health insurance. The broad categories include Platinum (covers 90% of your healthcare costs), Gold (covers 80% of your healthcare costs), Silver (covers 70% of your healthcare costs), Bronze (covers 60% of your healthcare costs), and Catastrophic individual health insurance plans (only pays after meeting a large deductible). These individual health insurance plans fall within these broad categories:

Health Maintenance Organizations

Also known as HMOs, these plans offer very little flexibility for network and provider choices, but, on the upside, have the least amount of paperwork.

Preferred Provider Organization

This type of individual health insurance coverage is known as a PPO and offers a little more flexibility than an HMO, but, if you see an out-of-network provider, you will pay a higher price.

Point Of Service

The POS individual health insurance plan is run through your primary care provider (PCP), if you want specialist care, you will need a referral with this type of plan.

Exclusive Provider Organization

Or an EPO provides some network flexibility but does not offer coverage for providers outside of your network.

High Deductible

This coverage can fit into any of the above categories (HMO, PPO, POS, or EPO), but reduces your premium by putting more burden on you for out-of-pocket costs. Deductibles typically start at $1400.

Catastrophic

This type of coverage for individual health insurance can include any of the above plans as well, but the deductible starts at over $8000 for an individual health insurance plan.

What You Should Include in Your Individual Health Insurance

Although the federal penalty for health insurance coverage is no longer in effect, there is still a federal mandate to meet a minimum coverage requirement for individual health insurance. Because the language is vague and focuses on “adequate” coverage, it might be easier to discuss types of individual plans that do not meet the federal requirements. Policies that are not major medical coverage and not regulated by the ACA do not count as minimum essential coverage. In addition to meeting these standards, you may want to consider other benefits that are not required:

 

Accident Supplement Insurance

This can help with extra costs associated with an accident. Make sure you understand how this supplement works with your individual health insurance plan, as it may have a narrow definition of “accident”.

 

Dental Insurance

Not all plans offer dental insurance, but you can often bundle coverage or add a supplement to most plans.

 

Vision Insurance

Like dental insurance, vision is not part of a standard health insurance plan, but can be an important add-on, covering lenses, frames, and annual visits to the optometrist.

How Individual Health Insurance Is Priced

Individual health insurance plans vary widely in monthly premiums. Finding an affordable individual health insurance plan means you will need to weigh the price of every benefit option. The sliding scale (Catastrophic to Platinum) of coverage options is a good first indicator for how much a plan will cost. Other factors will include deductibles and maximum-out-of-pocket costs. Still others will include your age and other health risk factors, but you cannot be denied or charged more for pre-existing conditions.

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Frequently Asked Questions

Answers to Frequently Asked Individual Health Insurance Questions

How much is Individual Health Insurance?

Premiums on individual health insurance plans vary widely and depend on multiple factors. To help find suitable coverage at an affordable price, it is advisable to consult with a health insurance agent at Ansay.

How to buy Individual Health Insurance?

Premiums on individual health insurance plans vary widely and depend on multiple factors. Speaking to a health insurance expert at Ansay is the best way to make sure you find adequate coverage at an affordable price.

How does Individual Health Insurance work?

There are a variety of options for your individual health insurance plan, and how much you pay out-of-pocket, whether you pay a copay or coinsurance right away, and how much you need to pay before insurance kicks-in all depend on your individual plan.

How to choose Individual Health Insurance?

There are a variety of factors to consider. Unfortunately, no one can predict when they will get sick or need to visit the ER. Having a plan that keeps you protected while remaining affordable might mean relying on an expert opinion to help you navigate your options.

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We are ready to help you navigate the challenges of finding the right individual health insurance plan at an affordable price. Make sure you are protected from illness or a trip to the ER – call Ansay & Associates and start comparing quotes today.

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