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Private Health Insurance Plans

Shopping for private health insurance can at times be confusing and time consuming.  If you previously had insurance through your company and find yourself looking for a private health insurance plan you will discover that it is on the expensive side because your employer is not footing the bill.  Although individual health insurance is much cheaper than group health insurance it can seem the opposite because when you are purchasing private individual health insurance on your own you typically do not have a nice employer offering to pay the premiums for you as with a group health plan. The average private health insurance premium for one person is $2,613 a year and goes up if you have a family to cover. 

Private health insurance policies are underwritten based on age, weight, smoking and drinking habits and health history.  Any preexisting condition, including common problems such as asthma, can be enough for an insurance company to raise premiums.  A history of anxiety or depression, heart disease, cancer or diabetes could cause an insurance company to refuse to underwrite your policy.  This means no private health insurance for the applicant unless they are able to qualify for a guaranteed issue health insurance plan (such as a HIPAA health insurance plan). 

The Different Options In Private Heath Insurance Plans

  • Indemnity Policy – Also called “fee for service”.  Indemnity policies give people the freedom to visit any health care provider, hospital or specialist of choice with few limitations.  In this type of policy there is usually a deductible and all costs are paid up front and then reimbursed by the insurance company.  Some indemnity policies do not cover preventative services such as check ups and routine visits.

  • HMO – Health Maintenance Organization.   HMO’s are usually negotiated by employers for lower costs with specific doctors, hospitals and clinics.

  • PPO – Preferred Provider Organization.  With a PPO the patient can use their own doctor but will save much more out-of-pocket money by using in-network providers as opposed to out-of-network providers.

  • POS – Point of Service – The patient can choose his or her own physician of choice who has agreed to discounted rates.  Before visiting a specialist or the emergency room, the primary physician must be contacted first.

Maternity Care And Private Health Insurance

Private health insurance companies don’t usually cover maternity care as part of a standard health insurance policy.  Women who are in the market for purchasing their own private health insurance should consider purchasing a maternity rider.  Most insurance companies will not allow you to add this coverage later and some companies will not allow purchase of this rider unless paperwork, such as a marriage license, is provided showing a change in marital status.  Where this seems somewhat discriminatory against single women, it is one way that insurance companies have chosen to keep their costs down. 

Regulation Of Private Health Insurance Companies

In 2007 health care spending cost $2.3 trillion dollars and it’s rising faster than inflation rates and is expecting to reach $3 trillion by 2010.  Health insurance is not regulated by the Federal government, but is regulated state by state and the companies are pretty much free to set their own regulations and limits on policies.  They can choose who and what they will and will not cover. This makes it all the more important to do your homework and research your insurance company thoroughly.

Ways To Lower Your Private Health Insurance Premiums

  • Co-pay plans vs. high deductible plans.  Co-pays are immediate benefits for your doctor and/or pharmacy that are not subject to and have no bearing on your deductible.  High deductible plans offer the same comprehensive coverage as co-pay plans. Choosing a high deductible plan without copays will usually be quite a bit cheaper than a traditional copay health plan.

  • Health savings accounts.  These allow you to use before tax money in a special savings account to pay medical claims until your deductible is met.  Depending on your health savings account, you can often use those funds to pay for co-pays and other medical costs not covered by your insurance including glasses/contacts, hearing aids, dentist appointments and dental care, over the counter medications and bandages.  In some cases if you have to travel an extensive distance to see a specialist you may be able to use some of your Health Savings Account funds to cover transportation costs.

  • Look for family rather than single person deductibles as well as annual deductibles in lieu of per incident deductibles.  One insurance company may offer a $2,000 per person deductible while another offers a $2,000 per family deductible.  This can make a huge difference especially if you have more than two children.

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