Health Insurance Medical Resources & Information

It is easy to get confused about individual health insurance, what with all the terms bouncing around amid America’s debate over health care. It can seem as if individual medical insurance is unattainable. The truth is, it isn’t.

Many people are in a situation where individual health insurance is not only an option; it is a necessity. People who need individual medical insurance include recent college graduates, newlyweds, people between jobs and those who are retiring early. Some could also be small business owners, the backbone of America’s economy. People could have left a group plan or simply be in the market for better individual health insurance. All these folks can benefit from considering individual medical insurance.

Basically, individual health insurance, whether it is individual medical insurance or group insurance, provides a resource for paying medical costs. A health insurance policy constitutes a legal contract between an insurance company and a group or individual. In this contract, the insurer agrees to provide health insurance benefits, as specified in the contract, for a mutually agreed-upon price, known as the insurance premium. The premium commonly is paid in monthly installments, although some people may choose to pay their premium annually in a lump sum.

Whether individual health insurance or group, insurance pays for medical expenses related to injury or illness. It pays either by reimbursing the individual or by direct payment. The kinds of medical expenses covered are specified in the contract between the individual and the insurer, as are the amounts paid for any given medical service.

Individual medical insurance can be purchased to cover a single individual, a parent with dependent children, or an entire family. Most Americans get their health insurance coverage through their employers or a government program such as Medicare or Medicaid. However, some 27 Million Americans buy individual medical insurance.

Independent salespeople known as brokers or agents sell individual health insurance in nearly every state. As independent salespeople, brokers and agents have the flexibility to offer insurance plans from different companies. This enables them to help individuals find the health insurance coverage that meets their needs best. Brokers and agents also help process claims and answer questions about a plan’s coverage in addition to the insurance company’s customer service staff.

Each state’s insurance department regulates the health insurance industry, making sure that premiums are the same for the same services. This means that individual health insurance purchased through any independent broker or agent will have the same price or monthly premium.

When presented with a range of options for individual medical insurance, a consumer is under no obligation to purchase any of the offered plans. Nor is he or she required to purchase a health insurance plan from an agent who may be consulted for a quote.

When applying for health insurance, individuals are typically asked to include a way to pay for the initial premium, such as a check, credit card number or bank account information for electronic funds transfer. Most insurance agents will not process this payment until the individual is approved for health insurance coverage. In the event the individual is denied coverage, or decides to cancel the application before it is approved, a refund will be issued if the credit card has been charged or the check cashed.

With the consumer in charge of the process for evaluating and applying for individual health insurance, there’s no reason for concern about getting such medical care coverage.

Individual health insurance plans and family health insurance plans, while basically the same, differ in degree of coverage as well as cost. Learn the difference between the two types of insurance products.

Individual Health Insurance Plans and Family Health Insurance Plans – Do You Know the Difference?

Trying to locate the right health insurance plan to fit your budget isn’t always the easiest thing to do especially with the growing cost of health care here in the United States.  Determining what you want a health insurance plan to accomplish for you and your family and determining the needs to be covered will help you decide what health insurance plan may work best you and your family.

What are Individual Health Insurance Plans?

The first place to start our discussion is with the individual health insurance plan.  An individual health insurance plan is basically what it says it is.  An individual health insurance plan is a health insurance plan for one person.  If you find you have no one else to insure with a health insurance policy then this will be your best option from a cost standpoint.  Keep in mind however that individual health insurance plans may vary widely in affordability depending on the type of coverage you choose for yourself.

The more traditional individual health care plan is called an indemnity plan.  The indemnity plan normally covers your visits to the doctor of your choosing and will cover the procedures that this doctor may prescribe for you.  The cost for this indemnity plan will vary depending upon a deductible you choose for herself as well as your out-of-pocket limit.  Keep in mind though that overall this type of health insurance plan is the more expensive of the individual health insurance plans but does offer you the most freedom of choice.

Individual managed care plans such as HMOs are less expensive than the indemnity plans but you need to be aware that you do give up some of the freedoms that are offered by the indemnity plan.  Your freedom to choose your doctor is limited to the doctors on the HMO’s approved list and any specialists that you may need to see will have to be referred by this primary doctor.  If primary yearly checkups and the occasional antibiotics describes your current health care needs, this plan may be the one for you.  This plan will cover health emergencies but there may be just a few more hoops you have to jump through than with the Indemnity health care plan. Both of these health insurance plans, the indemnity plan as well as the individual managed care plan, may include dental coverage and prescription coverage at an additional cost.

What Are Family Health Insurance Plans?

As the name implies, family health insurance plans are designed for families.  However since these family health insurance plans are covering more than one person, the cost of these plans will be higher.  As you may already have guessed, the larger the family the larger the price tag.  In addition, factors such as the ages, gender, and habits such as smoking or tobacco use in general etc. will largely determine how much this policy will cost you.  As with individual health insurance plans, there are indemnity plans that are available for families.  And since these indemnity plans offer the same freedoms as they do for the individual plans, these plans can be a real help when having to deal with the health care needs of multiple people.

Family health insurance can also come in the managed care variety as well and pretty much work the same way as do the individual managed care health insurance plans.  The cost of the family managed care plans will be higher than that of the individual managed care plan, but will cost less than a family indemnity plan.

What Are Group Insurance Plans?

Many companies are now offering their employees group health insurance coverage.  These employers may pay the bill for some of the premium.  Since many of these employers now offer both types of health insurance coverage, the type of policy you choose will determine your out-of-pocket costs.  Generally these group health insurance plans will cost you less than a plan you were to purchase on your own.  If this type of group insurance plan is available to you at your workplace, you’ll definitely want to take advantage of it.  If it is not offered at your workplace, perhaps you could suggest that your employer consider offering a group health insurance plan.

If your plan at work does not include a health insurance benefit or you are self employed or simply looking to provide health insurance coverage for yourself and your family outside the workplace environment, a great place to start your research is Blue Cross Blue Shield (www dot BCBS dot com) or Aetna (www dot aetna dot com). This is not necessarily an endorsement but is a good place to start in understanding the types of health insurance plans available out there today. These two large providers operate in most of our 50 states so your likelihood of learning about the types of health insurance plans available in your state from different insurers is high.

As always, seek the advice of a professional financial planner before deciding on a course of action that you do not fully understand.

Recently, Anthem Blue Cross–the largest provider of health insurance in California–proposed a significant increase in the price of its individual health insurance policies. The price hike of over 30% was set to take effect several months from now, and drew criticism from the Obama administration. Under current law, health insurance companies are regulated by the states. Health and Human Services Secretary Kathleen Sebelius only had the authority to write a stern public letter criticizing Anthem. In an attempt to resuscitate healthcare reform, Democrats pointed to the WellPoint subsidiary’s actions as a harbinger of what would happen in the health insurance market if their bill fails and the status quo remains.

It remains to be seen whether that tactic will revive support for health insurance reform, but there are indications that individual health insurance plans in several other states are looking to follow suit. In Maine, Anthem Blue Cross health insurance wants to increase its rates by nearly one-fourth; that’s on top of last year’s jump of one-third. Meanwhile, health insurance companies in Oregon have had their requests for 15% rate increases for individual health insurance approved. They, too, had also previously increased prices the year prior.

Many people have demanded an explanation for these price increases, especially during a recessionary period. Standard economic logic would have predict that lower demand from consumers with less money to spend would cause insurers to lower their premiums to attract more businesses. However, the health insurance industry is unique in that regard. In some respects, their costs are relatively fixed. Healthier people are more likely to drop their individual health insurance policies or switch to Health Savings Accounts and high-deductible health insurers plans with lower premiums. The people that keep their comprehensive health insurance in those circumstances tend to be those in worse health. Unhealthier people continue to use medical care. It costs health insurance companies money to fulfill their claims, while they are losing the more profitable individual health insurance consumers that generated income while using relatively small amounts of health care.

As a result, Oregon and Maine insurers–along with individual health insurance providers from California–have to increase their prices to maintain profit margins. Despite job losses, the employer-based group health insurance market has seen less volatility in sales. That, in addition to the larger risk pool that allows health insurers to spread costs, means that their rates have increased as significantly as those for individual health insurance.

What are the state health insurance regulators doing about this? Some states have no authority in the matter; they can negotiate with a health insurance company and plead with them to lower the level of proposed increases, but insurers don’t have to heed them. In these particular states, insurance departments can deny health insurers rate increases. However, individual health insurance companies can appeal the ruling or even sue to have it overturned. Oregon regulators approved several years’ worth of double-digit increases, since 2006 premium cuts caused individual health insurance providers to lose money. Unfortunately, the state insurance department’s reparations had exceptionally bad timing for its residents. In addition, they agreed with health insurance companies that an increase in diagnostic tests and higher service provider costs justified the rate increases.

Maine regulators have not been as charitable towards providers of health insurance. Originally, Anthem Blue Cross wanted last year’s average increase in the rate of individual health insurance to be 18.5%, but the state was able to hold the average consumer’s rate hike down to about 11%. The state is holding two public hearings on the issue later this month. Consumer protection groups are planning to attend in full force.

Proponents of healthcare reform claim that these increases show that the current system is not working, especially states like California or Maine, where a single health insurance company holds a near-monopoly. If there is a dominant individual health insurance provider in a state, it is easier for them to raise their rates without competition. A national health exchange market would attempt to bring prices down by promoting market competition, while subsidies and health insurance mandates are intended to help lower individual health insurance rates by increasing the size of risk pools. Anthem has called for the health insurance reform process to continue, because it has the potential to bring them more customers. Others believe that a better approach to the problem would be to allow insurers to sell policies across state lines, which would also serve to open up the market.

Product Description
Individual Health Insurance contains an up-to-date and comprehensive treatment of one of the most rapidly changing of risk management topics. The author is an internationally known expert on the subject and supplemented his knowledge with specialized expertise from several of his colleagues.

This book is the first of its kind since the text by Francis OGrady was last updated in 1988. It covers the history of the individual marketplace, the role of government health… More >>

Individual Health Insurance