By Alston Balkcom A
Purchasing an individual health care insurance plan can be scary for anyone who has always been insured by their company’s group insurance plan. I’ve specialized in helping my clients select good quality medical protection for well over ten years now and have been an insurance broker for over 20 years. I’ve outlined the steps we use to help our clients find the right coverage for their needs.
The 3 areas we look at are affordability, quality of coverage and the strength of the insurance carrier.
Company- Your health insurance company should be stable and have a history for paying claims.
Quality of coverage - The health coverage must meet your needs. It should cover doctors, hospitals, labs plus drugs. It should also have physicians and hospitals in their networks that are convenient to your home.
Affordability- Your health plan must be priced fairly relative to the benefits provided.
The basic process we use is to:
Determine which individual or family medical companies are worthy of being considered.
Determine which choices offered by those health care insurance companies offer adequate coverages
Determine which plans have the lowest overall cost relative to the health insurance coverage provided
Health Insurance Companies
An individual medical company should have good financial ratings and be in good standing with your state’s insurance department. You may also want to do a Yahoo! search for complaints.
You might for example search for “Mega Health complaints” before buying a policy from the company. Each healthcare company has some unhappy customers just by virtue of the volume of clients they have. However, a red flag should go up in your mind if the complaints are too numerous.
Another issue to look at is how much they pay in benefits as a percentage of the premium they take in. A good health insurance carrier will write checks for about 80% of the money they take in to cover their policyholders’ doctors and hospital bills.
Coverage - What does your health insurance plan cover?
There are 2 aspects of coverage. One is the treatments that are covered. The other is the network’s list of medical professionals that the insurance policy includes.
Covered Health Care Procedures
You should read through your insurance plan’s outline of coverage or official brochure to see how doctors, hospitals and prescriptions are covered. Your health care policy should cover you for physicians and hospitals and the hospital and should have a good lifetime maximum benefit. I suggest at least 5 million dollars of coverage.
Insurance Exclusions and Limitations in Healthcare Plans
Most if not all health insurance policies will have a list of treatments and services that are not covered. Most of the excluded or limited items in this section are reasonable and are included in the plans of most carriers also. Insurance Plans usually won’t pay for plastic surgery for example. There are are often limitations that you will discover in one insurance policy but not in another plan. Maternity insurance is one example of this. Most insurance plans will not cover the costs of a normal pregnancy. The ones that do tend to be more expensive when compared to otherwise similar plans that don’t cover maternity. The exclusions and limitations section of your policy or its brochure should be read carefully before you commit to purchasing any health care insurance plan.
Health Care Insurance Network List of Physicians and Hospitals
Knowing which physicians and hospitals are in your medical insurance policy’s network is an issue to address. You might be able to find a list of doctor’s who accept a given insurance plan online or by calling your health care insurance agent.
Affordability - Locating the best affordable health care plan
It is easy to compare personal health insurance costs, but its harder to make sure that you are getting good value for your dollars.
Selecting Between Healthcare Insurance Plans
After you have ruled out the companies with poor coverage and/or networks, it is time to look at price as a factor.
The Best Healthcare Insurance Coverage for the Money
The best medical insurance coverage, may not be the best plan for you. Often the best policy is overpriced and does not offer an extra dollar in medical benefits for each extra dollar it costs. Make sure that any plan you buy is:
Provided by a good medical insurance carrier
Will cover your health care needs well
Fits your budget
Alston Balkcom is a veteran insurance professional and has been serving in this capacity since 1985.
You can find personal medical insurance quotes on his site.
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