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Need more help deciding?Jeff Skeesick can answer questions you may have. 866.696.3154 orjskeesick@aiin.net

What is meant by “individual” health insurance?

The term “individual” insurance refers to medical insurance that is obtained privately rather than through a group. For instance, health insurance that is purchased independently as opposed to insurance acquired either through a government program or through an employer. Though it can be purchased for oneself, for a spouse or parent, as well as for dependent children or for an entire family, it is still termed Individual insurance. Individual health insurance plans are appropriate for people in the following situations:

• Those who have exhausted their COBRA coverage through a former employer's plan
  or who can't afford the cost of COBRA premiums.

• Persons who are self-employed.

• Students, spouses or other dependents who find it an economical choice rather than
  enrolling through a parent or spouse's group plan.

• Those individuals who have retired early but need coverage until they reach Medicare eligibility.

What’s best – a group or an individual insurance plan?

While there are benefits to both plans, Individual medical insurance plans can be a good fit for many people, offering important benefits, including:

Saving dollars through selection. In certain situations, a private medical insurance plan can actually save money for a healthy individual or family since individual medical insurance plans allow people to select only the coverage options they want or need. As a result, their insurance costs may be less than a group option that may not allow as various alternatives.

Providing portability. Another advantage of individual health coverage is that it can eliminate gaps in coverage should a change in employment occur. Insurance remains in effect, so there’s no need for COBRA coverage, which could cost more.

However, there are some important details to consider. The major difference between group insurance and individual plans is what is referred to as “evidence of insurability.” While most group insurance is issued without exams or other evidence of individual insurability, when seeking individual insurance, typically one must establish insurability. Individual health insurance plans use a process called underwriting to look at age, sex and health history to decide how much it will cost to provide healthcare.

 

To start the process, you’ll need to fill out a health questionnaire and occasionally you will be asked to complete a medical examination. In certain cases, insurance can be declined or granted only limited coverage due to a number of factors including medical history, age, income or personal habits. Each health plan has its own underwriting standards, but they must meet guidelines established through each state’s office of insurance. Few people are turned down, however, if denied, there are other options available.

 

Because everyone has different circumstances, it's an excellent idea to use the services and advice of a professional. Even if you think you would have difficulty buying health insurance, you should call one of our experts at inova to see if this is the right decision for you or if you are concerned about how to answer the Washington State Health Questionnaire.

What constitutes a “comprehensive” individual health insurance plan?

When referring to insurance, the term “comprehensive” refers to a health  insurance policy that will pay a sufficient amount – typically one or two million dollars in medical claims – over the lifetime of the policy, rather than so-called “discount” health plans that cover very limited claims even though advertised as adequate insurance coverage. Make sure to choose a plan with adequate benefits to protect both your family and your assets. Most bankruptcies in this country are caused by unexpected medical emergencies combined with inadequate protection. There are ways to be sure you are purchasing a plan with sufficient coverage to meet your needs:

Ask plenty of questions. Ask for the amount of the policy’s lifetime maximum in writing. Will the policy protect you from expenses caused by a major illness, accident or other catastrophic event? Is the carrier well known and financially-sound? How can the coverage be cancelled?

 

Get solid advice. Utilize an insurance producer to purchase insurance that’s right for you. At inova, we only offer comprehensive medical plans underwritten by financially-stable companies such as Asuris, UnitedHealthcare, Group Health, Lifewise, and Regence. Contact us today to learn more about the comprehensive health insurance plans for residents of Washington, Idaho and Montana.

What is a “catastrophic” medical plan?

Catastrophic is a term used to describe health plans purchased in order to cover large medical claims rather than day-to-day smaller health expenses such as prescription drugs or office visits. The key benefit of a catastrophic health plan is that it offers peace of mind while keeping premium affordable.

My position is being discontinued. My employer-sponsored benefits covered a pre-existing condition. Can I still get coverage for that condition if I become self-employed?

 

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) allows workers to extend employer-sponsored health benefits for up to 18 months after leaving a job. Though it will likely cost you more than your current coverage, as long as you continue to pay for COBRA coverage, you can’t be denied for your pre-existing condition. However, if your 18-month COBRA period ends (or you choose to obtain individual insurance plan and leave COBRA), you may be denied an coverage.
Be sure you know all your options ahead of time.

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