Individuals who don’t have health coverage through jobs can look to buy from private health insurance companies. Since premiums of private health plans are paid by the people themselves they are quite concerned about the private health insurance costs. People planning to buy individual private health insurance can read on for some tips.
About Private Health Insurance
Private health insurance plans are designed specifically for individuals and families, who are not covered under government-sponsored plans or through their employer and need to obtain health coverage for themselves and their families directly from their insurance companies or through the Health Insurance Marketplace. Most of the people in the US have health insurance either through their employers or through public health programs like Medicare and Medicaid, which are known to cover the largest group of population in the country. These health insurance plans are marketed by the private health insurance industry and it currently dominates the U.S. health industry offering coverage to more than half of the U.S. population.
Who Need Private Health Insurance Plan
Private health insurance is generally obtained by the following people:
Young Individuals – Young adults who are 26 years of age or older, and are no more covered under their parent’s health plan need to have their health policy.
Unemployed People – Individuals who have lost their job or who are no more eligible to continue with their employer’s health insurance plan under COBRA can opt to buy a private health insurance plan.
A Part-time Employee – Employees of part-time jobs are rarely offered with health benefits and hence they need to obtain health insurance on their own from the private health insurance carriers.
Self-employed – Self-employed individuals, who are not covered under their spouse or partner plan need to have their private health insurance to have coverage for themselves.
Employer – Employers, who have some employees are required to offer them health insurance and so they need to shop for a private group health insurance plan.
Retired Person – Retired people no longer remain eligible for an employer-sponsored health insurance plan. And if the retired person is under 65 years of age and not disabled then he/she will certainly require a private health insurance plan until they turn 65 and become eligible for Medicare. Even if the person is 65 years or older and is eligible for Medicare then also he/she will need private health insurance for their family members because Medicare plans do not come with family coverage.
Dropped by Existing Insurer – Though ACA has prevented the insurer from canceling coverage or penalizing insured for a pre-existing condition but still if a person gets dropped by their existing insurer, then he/she will need to obtain private health insurance coverage.
Health Insurance Shouldn’t be Skipped
Individuals should remember that health insurance shouldn’t be skipped in any circumstances even for a single day. Though there is no ACA fine for not having coverage still people should invest in these most crucial life expenses. A medical emergency can occur to anyone and anywhere and receiving medical treatment without health insurance is too expensive and generally not affordable for many. Though not everyone might be able to afford the type of plan an employer would offer but still, any plan is better than no plan and people must check their options through the ACA Health Insurance Marketplace that whether they qualify for income-based premium tax credits or cost-sharing reductions. By having a health plan people will have peace of mind that they will be covered in case of a major medical illness or accident that lands them to hospital.
Type of Private Health Insurance Plans
Luckily people shopping for private health insurance plans are offered with some choices, as the private health insurance market offers different types of health plans for individuals and families. Different types of health plan include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Exclusive Provider Organization (EPO)
- High Deductible Health Plan (HDHP)
- Point-of-Service Plan (POS)
- Consumer-driven Health Plan (CDHP)
Besides these plans, depending upon their circumstances individuals also have the option of short-term and catastrophic plan options. After carefully choosing a specific type of plan, people also need to determine a deductible amount with which they are comfortable along with their out-of-pocket expenses every year in a worst-case scenario. People should be aware that lower premium plans come with higher deductibles so people with mow monthly income may have to opt for a higher deductible plan. People should also keep out-of-pocket expenses in mind while shopping for health plans.
Cost of Private Health Insurance Plans
People generally hold a perception that buying private-health-insurance is an expensive affair, however, data show that it is not always the case. Sometimes these plans turn out to be more affordable than employer-sponsored plans. As per the Kaiser Family Foundation study, the average monthly premium for a company based individual health plan was $574 in 2018 and was $1,634 for a family health plan. During the same time, the average cost of individual private health insurance was only $440 and the average monthly premium for the family plan was $1,168. This is simply because when people buy a health plan on the Health Insurance Marketplace they may qualify for Advanced Premium Tax Credits or for a Cost-Sharing Reduction subsidy that generally lower the premium amount and also help people pay their deductibles, co-payments, and coinsurance.
Options to Buy Private Health Insurance Plans
Individuals who are planning to buy private health insurance plans have the following options from where they can check the plans available and that best suit them. People have the following options to buy and check details of the private health plan:
Medicare.gov – People who are retired or soon will be retired can check their insurance coverage options at this site. At this site, people will not only find information on Original Medicare but also for Medicare Supplements and Advantage plans too.
Healthcare.gov – People who don’t fall in the Medicare category can check their health plan options under the Affordable Care Act at Healthcare.gov. This is the site where they can check whether they qualify for any cost-sharing plans and its application process. Besides ACA, this site also provides information about private health insurance plans available outside the Marketplace.
Private Health Insurance Companies – Individuals can visit major health insurance companies websites operating in their area to look for available private health insurance plans along with their coverage and deductible. Health plans vary by state, and premiums for each plan vary by ZIP code. People should remember that the price of the plan quoted on the website is the lowest available price of that plan for the individual who is in excellent health.
Key Factors helpful for Choosing a Private Plan
Health insurance plans come with a variety of features and it is unlikely for people to find a plan that offers every benefit that they would like to have in a plan. Thus, people should look for the features in a plan that they require the most. In this way, they will find the plan that offers the greatest number of benefits at a price that they can afford. Some of the features that people should check include:
- If people have already selected a doctor for their healthcare needs then they must find a PPO or EPO plan that includes their doctor in the insurance company’s provider network.
- People should check the office visit copay, and whether the plan has capped the number of office visit it will cover per year or not.
- Check whether the plan includes prescription drug coverage or not and check whether only generic drugs are covered or branded drugs are covered too.
- People who are already taking medicine should check whether their medications are included for coverage in the plan or not.
- Individuals must be aware of the copay for professional medical services like x-rays, lab tests, and surgery.
- Check whether the plan allows them to include dental and vision coverage at minimal cost or not.
- Does the plan include free or discounted service for preventive care like an annual check-up or no, as all the ACA compliant plans provide free preventive care coverage?
- Must check the cost for out-of-network services for the PPO plan and should consider whether they can afford it or not.