If you’re not covered by a group plan (with an employer, for example), then you’ll have to begin searching for the appropriate individual medical insurance that fits you and your situation best.
Following are eleven things to consider when purchasing medical insurance:
Medical Insurance Premium- Make sure you thoroughly shop around because premiums for similar medical insurance coverages from different insurance companies can vary by as much as 50 percent.
HMO’s (Heath Maintenance Organizations) have a more comprehensive coverage and less out of pocket expenses but premiums may be quite a bit higher.
Major Medical Plans may provide the most flexibility with doctor and hospital choice but payout the least after deductibles and coinsurance payments.
As a hybrid of HMO’s and Major Medical, PPO’s (Preferred Provider Organization’s) may provide a good premium value but not cover as much as the other plans.
Costs- Besides premium consider co-pays, deductibles, coinsurance charges and the out of pocket limits.
Deductibles- The higher the deductible the less your premium will be but make sure you can afford it.
Comprehensive coverage- If you want a comprehensive, preventive plan with few out of pocket expenses, you might want to consider an HMO.
Prescriptions- Review the coverage and see if your current prescriptions will be covered and at what level.
Specialists- If you prefer certain specialists such as an acupuncturist and a chiropractor, make sure you check the policy to see if those costs will be covered. Also, mental health treatment may not be covered or be covered on a limited basis.
Stay Covered- Even if you have to buy a short term medical policy, stay covered. If you go without insurance for 63 days or more, you can lose your rights to pre-existing condition coverage.
Doctor- If you have a doctor you like, you might have to select a Major Medical or a PPO plan where you’ll be able to pick your doctor. Or you can check and see what network your doctor is in and pick a plan accordingly.
Anticipated Health Care- What are the projected health care costs for you and your family? For example, if your child has allergies, does he have to see an allergist routinely to keep them under control? Factor this into your decision.
State Laws- The ability to get a policy and what kind of policy you can get largely depends on your state laws and regulations. For example, some states allow medical underwriting and some don’t. Medical underwriting is where insurers can reject people with certain illnesses, charge higher premiums and exclude certain conditions from coverage.
Emergency Care- What will it cost for emergency care service? For example, some policies will pay for a broken arm due to an accident but will not cover an illness that was treated in the emergency room.
You can also have a situation where a visit to the emergency room will be covered but an extended stay in the hospital will not be.
Since emergency care can be costly, make sure you read the policy fine print about this coverage.