Tuesday, October 5, 2010

Hunting for health insurance? Do your research

The new health care law promises help for people who cannot rely on an employer-based plan to cover their insurance needs. But that doesn't start until 2014, and millions are expected to need individual plans in the meantime.
Many should be able to find what they need by doing some research, asking the right questions about coverage and using some government help that's already available. Here are basic steps to take before choosing a plan:
— Think about your needs.
Consumers can't find a policy that suites them unless they understand what they need. If you see the doctor frequently, a plan that limits those visits to four times a year would not be wise. But that could be an option someone in his 20s who rarely gets sick.
Likewise, a plan that doesn't cover pregnancy wouldn't be smart for people who want to start families. Some options only cover generic drugs, and that means big pharmacy bills for someone who depends on a brand-name prescription medication.
"Once you can identify what the health insurance needs are . that will kind of dictate what your monthly premium will be," said Keith Mendonsa, a consumer health insurance specialist with eHealthInsurance, an online insurance broker.
Before searching for insurance, think about whether you can be added as a dependent to the existing coverage of a spouse or parent.
— Do some research.
Premiums, or the price of an insurance policy, vary widely depending on variables such as age, health, where you live and how you want your coverage set up. One place to start sorting options is the website www.healthcare.gov , which is managed by the Department of Health and Human Services.
The site walks consumers through plan design, helping them find coverage options based on their states and other factors that could affect their rates. It was put together by people who "care about actually being useful to consumers," said Nancy Metcalf, a senior program editor with Consumer Reports who is not involved with the site.
"All of the policies you are going to see are going to be decent policies, and they'll also say if some stuff isn't covered," she said.
— Consider a broker.
Licensed insurance brokers can help customers quickly sort through their options, and they can be especially useful for people who have pre-existing conditions. For people with diabetes or recovering from cancer, finding individual coverage can be difficult or impossible depending on the state in which they live.
Some people also can be turned down because they take high-blood pressure or cholesterol medicine or they recently had hip surgery, Metcalf said. Brokers know which insurers will reject certain conditions, which can save some grief.
— Look closely at coverage details.
Most policies contain a summary of key numbers. Consumers should examine at least five: the premium, deductible, co-payment, coinsurance and the maximum amount the policyholder can expect to pay out of pocket each year.
The deductible is the annual amount a patient pays for care before coverage starts. High-deductible plans come with lower premiums.
Coinsurance is the percentage a patient pays for medical care generally after a deductible is met. These percentages mean you still could wind up with a big bill for a surgery even if you have good coverage and you've met your deductible.
The annual maximum is how much you have to spend on coinsurance and other costs before the insurer takes over and covers the majority of your remaining expenses for the year.
"This is your maximum financial exposure, and it's a big deal," Mendonsa said.
— Be careful
Make sure you understand all the coverage specifications before you pay for a policy. You also should know if your doctors are in the insurer's network because it will cost a lot more for care and visits if they are not.
It also pays to understand hospital coverage and the limits a plan places on it.
"You don't want to be blindsided," Metcalf said.


  1. Thanks for the info. Im retarded about insurance.

  2. Interesting! We need articles like this in these days

  3. Great post!

    looking forward to reading the next one

  4. Very true, being blindsided is the worst thing that could happen.

  5. this is pretty interesting. insurance is a little weird though. i would rather be super careful, and so far i have been, but paying for it

  6. Good to see someone well informed about health insurance. It's getting really tough out there in the market, and I'll definitely read this up.

  7. great informative post...followed :)

  8. i like this alot, great post!!!!

  9. You can always move to Canada too!

  10. Thanks for sharing, great stuff =)

  11. health insurance is so complicated, and it won't get any better

  12. aw yeah, the jungle of insurances...

  13. interesting read :) thanks for the tips

  14. Fortunately, for the time being, I'm reinstated under my parents health plan due to the extension from the bill.

  15. I think I learned something from that. :o
    Good read.

  16. i'm so glad i liv in germany. we have the best health-insurance-system you can imagine