THE INDIVIDUAL HEALTH INSURANCE MARKET TODAY
Welcome to the ever changing world of Individual Health Insurance. Previously health maintenance organizations (HMO’s) were the answer to the rising cost of health care; now they are the problem. Many medical groups and doctors accept only preferred provider organizations (PPO’s). Some new affordable health insurance plans offer both first dollar coverage and a catastrophic cap, with the subscriber paying costs “in the middle”. Carriers have gotten creative with various cost sharing plan designs for Individual Health Insurance to keep premiums in check and still avoid catastrophic loss to insured. Some Individual Health Insurance plans require subscribers to pay 100% of medical expenses at discounted rates, up to the deductible, before the carrier pays 100% of the costs for the remainder of the calendar year. Health Savings Account (HSA) compatible Individual Health Insurance plans are quite popular. The HSA Individual Health Insurance plans offer tax incentives for saving for future medical, dental and optical expenses. HSA compatible Individual Health Insurance plans often have low monthly premiums and lower maximum risk.
There are many questions for the Individual Health Insurance industry. One of the most important is: How do people who are not perfectly healthy secure Individual Health Insurance? For those with minor treatable illnesses or who are on medications, choices are limited. All carriers advertise preferred rates to individuals. After an application is received and reviewed, the underwriter may decide to deny or offer coverage at a higher rate. Reasons providers may surcharge for Individual Health Insurance include: smoking, uncontrolled blood pressure, asthma, and/or expensive medications.
If you are denied insurance coverage, you may be eligible for the major risk medical insurance program (MRMIP). This state-subsidized medical insurance program has a waiting list of up to a year. The budget for MRMIP has decreased which means applicants are accepted on the plan, but at a much slower rate.
If your COBRA plan or Employer plan is due to terminate, the Health Insurance Portability and Accountability Act (HIPAA) may help you get coverage. This law guarantees applicants Individual Health Insurance coverage as long as it is put into force within 63 days of the loss of group health insurance coverage. The HIPAA plans offered are not as diverse as the traditional Individual Health Insurance plans on the market, but affected persons will at least be able to secure some type of health insurance coverage.
How does all this affect you? It really depends on your particular situation and your medical history. Discuss your situation with an experienced agent who knows the options available. If you have questions about Individual Health Insurance or are interested in getting Individual Health Insurance coverage for you or your family, give us a call and we’ll review the plans and options available.
