How to Choose the Right Individual Medical Insurance

2007-03-08 10:33:40

( Health )



If you are self-employed, you may feel that choosing the right individual medical insurance plan is a tough activity. However, knowing the different types and extents of coverage can help you make a good educated choice that will not burn a hole in your pocket.

Types of Individual Medical Coverage

The most traditional type is the indemnity coverage, wherein you could go to any doctor or hospital. You usually need to pay a small deductible each year before your insurer starts sharing the cost of your bills.

On the other hand, managed care plans have agreements with specific doctors and hospitals to provide a range of medical services to plan members at reduced rates. Under this category are the preferred provider organization (PPO), health maintenance organization (HMO) and the point-of-service (POS) plans.

The PPO set-up most closely resembles the indemnity coverage in that you can choose from doctors and hospitals which are part of a network. In-network doctors and facilities charge lower fees.

The HMO is the oldest form of managed care plan, where you visit the doctors at central medical offices which are also owned and maintained by the HMO. You choose a primary care doctor who maintains your health records and you need to contact him or her to be referred to any specialist.

Under a POS plan, you don't need to wait for your primary care doctor to refer you to a specialist. Amount of fees charged also depends on whether you see an in-network or out-of-network specialist.

Considerations for Choosing an Individual Medical Plan

You need to find out if your plan can handle the basic medical services such as physical check-ups, specialist care, prescriptions and tests. If you have children, you may want to know if immunizations and pregnancy health screenings are covered. Can the plan also handle special needs such as mental health counselling, physical therapy or hospice?

Freedom to choose a doctor and facility is also a major concern. If you are opting for a managed care plan, you might want to obtain a list of the doctors and facilities that are part of the health plan's network.

Cost is also a top consideration. Generally, more freedom to choose a doctor/facility and more services covered translate to higher cost. Following this logic, indemnity plans are priciest while HMOs are cheapest. Be aware not only of the monthly membership fees, but also of the copayment rates for visits, services and prescriptions.

Where to Get Information

Most health insurance companies have online sites where you can obtain individual health insurance quotes and other information immediately by just filling in some information. You may also call your insurance agent.

Recommendations from relatives and friends are extremely helpful, and you can also learn more about the reputations of various insurance companies.

But always remember that the best individual medical plan for someone else may not be the best one for you.


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