Individual Health Insurance
Individual health insurance is a type of coverage that you purchase on your own or a family basis. This coverage is not obtained by employer or state programs like Medicare, Medicaid, and CHIP (children’s health insurance program).
It is for everyone who doesn’t have access to health coverage sponsored by an employer or the government, including self-employed people, people who work in small companies (which don’t provide health insurance), students, or those who quit working before the age of 65 (aren’t eligible for Medicare yet).
Types of individual health insurance plans
Affordable Care Act Plans (ACA Plans)
These types of plans must fulfill requirements under ACA and they are the most extensive plans on the market. They have to cover a minimum of essential benefits for individual and family coverage. They are part of major medical health insurance plans and can also be purchased through licensed brokers in Better Place Insurance Group who are selling qualified health insurance plans. The good thing is that these plans have a large range of health providers and are available to almost everyone. Their popularity increased after January 2014, when increased rates based on medical history were abolished which means that their applicants can’t be rejected on the grounds of their pre-existing health conditions.
The four main types of ACA Plans are HMOs, PPOs, EPOs, and POSs. There is also a Catastrophic plan which is designed for people under the age of 30.
Even though there are several differences between these types, all of them provide these 10 things: emergency services, hospitalization, out-of-patient services, maternity leave, prescription drugs, substance use for disorder services (like mental health and behavioral problems), pediatric services (including oral vision and care), preventive services for chronic illnesses and rehabilitative services.
HMO Plan ( High Maintenance Organization Plans)
This type of ACA plan is one of the most popular plans on the market because it includes an entire network of healthcare services. However, you must choose your primary care provider first who will coordinate all of your needs. So, you’ll need a referral to see a specialist. This plan provides you with lover out-of-the-pocket costs but you must visit doctors that are in HMO’s networks. If you go outside of a network you will have limited coverage or maybe no coverage at all. Also, you’ll pay for additional costs for visits that aren’t medically necessary. This can be a great plan for individuals and families who visit their doctor on regular basis.
PPO Plan (Preferred Provider Organization)
Unlike the HMO plan with this plan, you can see any doctor in PPO’s network without a referral so you don’t need a primary care doctor to get the referrals for seeing a specialist. With this plan, you’ll have the highest benefit level of care services that your provider’s network is covering. There are also copayments for services that are not medically necessary. This type of plan is good for individuals who often see specialists.
EPO Plan ( Exclusive Provider Organization Plan)
By purchasing this plan you’ll have access to all providers within EPO’s network, including specialists. The plan doesn’t provide coverage for visits to an out-of-network doctor, except for medical emergencies. This plan can be a good choice if you don’t want a PCP to coordinate all of your healthcare needs.
POS Plan (Point Of Service)
This is plan is a combination of HMO and PPO plan. This means that you need to determine your, primary care doctor, for regular visits and to get a referral to see a specialist. But, this means that you’ll be able to see an out-of-network doctor. However, this plan has larger costs. You will have to pay deductibles and copayments but you’ll have more flexibility in choosing your services.
Those plans are designed for younger individuals that don’t need constant medical care. This plan also must cover 10 benefits that are under ACA but it covers at least three visits to a primary care doctor per year. Those visits should be with an in-network doctor to avoid additional costs. It features lower monthly premiums with higher deductibles.
Short-term plans are usually for individuals who are in transition periods, like students who need temporary coverage in the state where they are studying, unemployed people who are waiting for a job, people who are waiting to be eligible for Medicare, and those who missed enrollment period for ACA, etc. They aren’t part of major medical health insurance plans. This plan offer coverage for individuals and family for short period and even though they are less expensive than ACA plans they also have fewer benefits. Short-term coverage can vary from plan to plan. If these plans don’t fulfill ACA requirements your medical needs may be uncovered.
Medical Indemnity Plans
These plans are also known as fee-for-service plans. With these plans, you can see any doctor you want without a referral to a specialist. Also, you don’t need to choose a primary care physician with this plan. You may pay an annual deductible before the insurance company starts to pay for your needs. This type of plan can be good for individuals who are looking for more flexibility in choosing doctors and hospitals they want to visit.
How to manage costs for individual health insurance plans?
Most insurance plans are listed with associated metals: bronze, silver, gold, or platinum. Each of those metals is associated with an actuarial value. Actuarial value is the average percentage of medical costs that your insurer pays each year. The Bronze level has an actuarial value of 60% (insurers pay for 60% of their policyholders’ medical costs). Silver has 70%, Gold has 80%, and the Platinum level has 90% of an actuarial value.
Worse metals have lower monthly premiums and a lower percentage of healthcare costs. Better metals have higher monthly premiums and a higher percentage of healthcare costs. Also, the cost can vary between the types of plans you have.
When can I enroll?
For ACA or Obamacare plans there are Open Enrollment Period and Special Enrollment Period. Everyone can purchase those types of individual and family healthcare plans. OEP happens once a year from November 1st till December 15th. If you miss this period you’ll still be able to get it if you qualify for the Special Enrollment Period based on life events like a recent marriage, recent divorce, moving to a new zip code country, etc. If you miss the Open Enrollment Period and don’t qualify for the Special Enrollment Period Better Place Insurance Group still can offer you other types of plans, like short-term individual plans.