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What are family and individual health insurance plans?
What types of individual and family health insurance plans can I obtain?
What are PPO health plans?
What are HMO health plans?
Is there a difference between physicians that are in-network versus those that are out-of-network?
Should I put my spouse and children on my work's group plan?
Can I get individual or family health insurance if I have a Pre-Existing Condition?
What if I can't afford health insurance?
Individual and family health insurance plans ensure that all members can access the medical care they need. The health insurance rates on our plans are low and affordable, and the plans offer great coverage, meaning there is no reason why you and your family should go unprotected. An individual health plan can help you if you do not have health insurance through your job or if you are looking for health plans and are self-employed. Family health insurance plans can cover your whole family, including your spouse and any children you may have.
There are two types of family and individual health insurance plans. These are "managed-care" plans and "indemnity" plans. There are a few differences in these individual health plans. The biggest difference comes in the up-front costs, as healthcare insurance providers will bill things differently. In most cases, a managed-care plan will have fewer providers than an indemnity plan. However, with an indemnity plan, the healthcare insurance provider will only pay for your medical coverage after they receive your bill, and there may be some upfront charges for which you will initially pay. You will then wait to receive reimbursement for these charges.
If you choose a managed care plan from your healthcare insurance provider, you will also need to know that there are multiple types. HMOs, and PPO plans are all considered to be managed care plans that require you to use the healthcare insurance provider's network.
On these plans, the services that you receive have pre-determined prices, and the network submits your bills to the health insurance companies for you. This equals fewer costs upfront for you to pay, though you will be limited to what providers you can see.
With a PPO health plan, also known as a preferred provider organization plan, your private health insurance provider will give you a network of doctors and hospitals that are preferred by the company. If your doctor or hospital is a part of this network, you will receive discounted rates. In most cases, your health insurance provider will not require you to choose a primary care physician; instead, you are free to see anyone in the network.
With some individual health plans, you will have an annual deductible that will have to be met before the insurance company begins paying. You may also have copayments or other payment requirements to be met on your family health insurance plans before coverage will begin.
If you see a doctor that is not a part of your health insurance provider's network, you will generally have to pay more.
An HMO health plan, also known as a health maintenance organization, is an individual health plan that exchanges the number of available doctors and hospitals for lower upfront costs. A person with medical insurance with an HMO will have to pay less up front, but will have fewer doctors to choose from when they need care. These family health insurance plans require you to choose a primary care physician who will oversee the majority of your medical care. If you need to see a specialist or a different physician, you will need a referral to ensure that your health insurance provider will cover the costs.
With an HMO, you receive a large range of preventative health care services. The health insurance provider also does not typically require a deductible, and any copayments are generally small. While on this individual health plan, you will only be able to see doctors and hospitals that are in the network.
If your private health insurance plan has a network, then there is a large cost difference between doctors that are in the network and who that are not. Physicians that are in the network have a contract with the health insurance provider to provide their services at a set price. In most cases, for services covered under your family health plan, you will only have to pay any copayments and/or deductibles. However, a doctor that is not in your network does not have this same contract with the health insurance provider. Because of this, many health insurances companies will not pay for you to see an out-of-network provider, or they will only pay a portion of the bill. An Indemnity plan usually does not have a network, and you can see whichever doctor you choose, but HMO, and PPO plans generally have networked providers. Depending on your individual health insurance plan, you may have a wide selection of healthcare providers to choose from, or you may only have a limited list.
Yes and no. YES if your spouse or a child has a serious or chronic condition that has been treated or diagnosed. Serious, chronic and pre-existing conditions can sometimes be denied by insurance companies offering individual and family plans, but by law must be covered under employer group plans. NO if you want the similar benefits for a lot less money.
For most of you, health insurance companies will consider you and your children healthy. On your employer's plan, which is required by law to cover all healthy and unhealthy people, you will pay more for the same benefits because you, as a healthy person, must pay to help offset the costs of the unhealthy people. Whereas on an individual or family plan, you only pay for you and your family, often saving a lot of money. Sometimes saving up to 50% per month.
If you want to insure that your family always has the health insurance they need. With employer-based insurance, keep in mind that your family may lose that insurance when you leave that company. And if anyone has been treated for a serious illness, then that can be problematic when trying to secure health insurance on your own.
However, once your family is on an individual or family plan, they will always have the health insurance coverage they need no matter where your career takes you. Provided you keep the insurance in force.
Yes, you are eligible for individual health insurance even with a pre-existing condition. However, there are several options available to health insurance companies when they look at someone with a pre-existing condition. One, they can deny coverage outright. That is, if they look at your pre-existing condition and determine that it is too severe to insure, they may decline offering you coverage. This is a risky position for you to be in because once one health insurance company has denied you, then most of the others are likely to follow suit. If you think you have a pre-existing condition, please seek several resources before applying for a plan. Two, they can issue a Condition Specific Deductible. This is something where they grant you full health insurance coverage on everything except the specific pre-existing condition. For that, they provide a separate deductible limit, almost always considerably higher than a typical deductible, to minimize their risk on that specific condition. Three, they can exclude that condition specifically. That is, an insurance company may offer you full health insurance except on that specific pre-existing condition that they decline to cover at all. Four, they can choose what is called "rating" your plan. This is when an insurer will increase the price of your plan by a certain percentage to cover their potential costs of covering the condition. For example, if your plan costs $100 per month and is "rated" up 25% based on a specific pre-existing condition, then you would end up paying $125 per month for the same benefits.
Family budgets can become tight. We certainly understand this. Our own family budgets can get tight. And for some families, the simple reality is they can't afford health insurance. If you feel that you and your family fall into this situation, please contact your state Medicaid office to see if you are eligible for help. However, if you are like most of us, you may not think you can afford health insurance, but the truth is private health insurance can be remarkably affordable. In most states, individual and family plans can cost up to 50% less than plans you can get through your employer with similar benefits.
