More Americans are buying their own health insurance, but the process can be tough. There are ways to make sure you understand what you’re buying, and that you get the product that’s best for you.
You may want to start by confirming that you really do need to buy individual insurance. For many people, it’s better to avoid the individual market, since in most states insurers can reject you because of preexisting health conditions.
The Kaiser Family Foundation web site is a good place to start in researching your eligibility for various government programs or, if you are losing coverage because of a layoff, continuing workplace benefits through the federal law known as Cobra. Once Cobra coverage runs out, insurers may be required under federal law to sell you another policy, though there’s no guarantee on the price. But different states implement this rule in different ways.
If you are going to buy your own insurance, start your research with Web sites that explain the basics, such as healthinsuranceinfo.net, sponsored by the Georgetown University Health Policy Institute, and healthcarecoach.com, from the nonprofit National Health Law Program. They will help you understand the concepts and language of health insurance, which aren’t always easy to grasp, and should give you some sense of the questions to ask about any plan. Healthinsurance.org has useful information, but be aware that the site also provides insurance quotes from what it calls “carefully chosen partners who are in the business of selling health insurance.”
Then you can noodle around on Web-based brokerages that sell health insurance, including eHealthInsurance.com, HealthPlanOne.com, HealthInsurance.com and InsureMonkey.com. You can get estimates based on limited anonymous information.
Some consumers choose plans based solely on online research. But without guidance, it can be tough to fully understand the nuances of a plan and how it compares to other options. First, make sure you’re actually buying insurance, not some other product such as a discount card – one key way to tell is by checking with your state regulator that the company selling the product is considered a legitimate insurer. Be very careful about limited products such as temporary insurance, which last for a set period of time, since you may not be able to renew such a plan at the end of that period.
When you examine policies, don’t just look at premiums. Figure in other fees you will face, such as a percentage of the cost of doctor visits. Make sure you understand the policy’s annual out-of-pocket maximum, meaning the most you might have to spend in a year, since certain charges might not count toward the total. Some insurers require you to track your own spending and tell the company when you have reached your maximum, which might be a headache.
Read the fine print about your deductible, which is the amount of money you must lay out before your insurer starts paying. Some policies may have multiple deductibles, including one for each family member. Insurers may also not count certain costs toward the deductible.
Also, watch out for benefit limits, including annual and lifetime maximum payouts. So-called “mini-med” policies that cap their payouts can be dangerous, since you might end up paying bills for thousands of dollars if you have a major illness or surgery. Certain plans pay only a set fee per day of a hospital stay, which could leave you on the hook for thousands of dollars. Drug benefits don’t always include every medication. Some policies exclude maternity coverage, or don’t include care for pre-existing conditions.
And keep in mind that just because something isn’t in the “excluded benefits” section of your plan doesn’t mean it’s actually covered. For instance, insurers typically refuse to cover all treatments they don’t consider “medically necessary.”
Before making a final decision to purchase a policy, closely review the full plan explanation, sometimes called the certificate of coverage or the evidence of coverage, and seek help from the Web brokerage’s agents or other experts if you don’t understand it. Insurers may let you review this this document only after you tentatively choose a plan and are accepted for coverage.
First-time purchasers should strongly consider consulting several independent agents before buying to compare their advice. To find an agent, ask friends or family members for recommendations. You can find agents who specialize in health insurance through the National Association of Health Underwriters. Online brokerages also typically have live agents available to answer questions by phone.
Check with your state regulator that an agent has a valid license and a clean record, and make sure health insurance isn’t a sideline or a new specialty. You want an agent who represents a number of major insurers, rather than just one company. You also may want to ask agents how they’re compensated. Agents get commissions from insurers for each policy they sell, often calculated as a percentage of a customer’s premiums. These can range from around 3% to as high as 20%, according to agents and insurance officials. You want to know if your agent will make more money from selling you a certain plan. Also, commissions can be higher in the first year of a policy, an incentive for unscrupulous agents to “churn” clients, or try to get them to switch policies.
An agent should learn your financial limits and any health issues. One good sign is if an agent asks about your eligibility for government programs or the Cobra subsidy. These make no money for the agent but may be the best options for you.
An agent should help guide you toward the insurer most likely to accept you. Keep in mind that if you are rejected by one carrier, you will probably have to disclose that in future applications. An agent also should help you fill out the application. But make sure that you know what’s in the application and that it is accurate. If you make mistakes, you may give the insurer an opening to rescind your policy later.
Finally, you should expect your agent to continue advising and helping you even after you purchase a policy. If you aren’t satisfied, you can change agents. In many cases, you can also redirect the flow of commissions tied to your plan to your new agent by informing the health insurer that you want to designate a new agent of record.
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