How to Get Health Insurance
While you may not need life insurance, and you might be willing to risk not having earthquake insurance, don’t gamble with health insurance. Just a couple of days in the hospital can drain almost anyone’s savings. Health insurance can be expensive, but with a little research, you can find coverage that fits your budget.
- Sign on with the health insurance provided by your employer: it is likely to be the cheapest option you can find. Search for your own insurance if you’re self-employed, or if your company doesn’t offer it.
- Investigate coverage under COBRA (Consolidated Omnibus Reconciliation Act of 1985) if you’ve recently left your employer. Through COBRA you can extend your coverage for 18 months beyond your separation date, though you have to pay the premium yourself.
- Find a health insurance broker to compare plans and costs for you. The National Association of Health Underwriters (nahu.org) can help find one in your area.
- Purchase a fee-for-service plan. The biggest plus is that you have complete control over which doctor you see and determine for yourself when you need to see a specialist. However, there is a significant out-of-pocket cost for this kind of care, the premiums are generally higher, and if your doctor charges more than what is considered customary, you may have to shell out additionally for that care as well.
- Sign up for a managed care plan where your insurance provider determines which doctors you can see. There are three basic kinds of managed care:
- Preferred provider organizations (PPOs) have a list of doctors to select from when choosing a physician who will be your first contact for health care. If you see doctors in your insurer’s network, you pay a low co-payment. However, if you see a physician not in the network, your co-pay is higher. You also generally don’t need prior approval to see a specialist–PPOs give you the most flexibility but cost more in monthly premiums and out-of-pocket costs.
- Point-of-service (POS) networks are similar to PPOs, except that your primary care physician makes decisions about which specialists you can and can’t see. You can still see a physician outside the POS network, but face higher fees and more paperwork to do so.
- Health maintenance organizations (HMOs) are the most restrictive, yet least expensive managed care programs. Most require that you see a doctor in their network, but offer low or no copays in exchange. Many HMOs also require you to see your primary care physician before getting referred to a specialist.
- Find out if benefits are limited for preexisting conditions, or if you have to wait for a period of time before you’re fully covered. Other plans may completely exclude coverage of preexisting conditions.
- Compare the prescription drug coverage offered by various plans. Many plans have tiered benefit systems, and usually offer a preferred list of prescriptions that have a lower co-pay. Search for any medication you are taking on this list; drugs not on the list can have a co-pay that is twice as high. Also, see if any plans limit the amounts of new prescriptions or refills on a given drug.
- Check to make sure your regular doctors are on your plan’s preferred provider list. All plans provide a database of their provider list on their Web site. Go with a plan that lists most or all of your regular doctors. Be aware that most PPOs will pay up to 20 percent less for out-of-network doctors.
- Investigate what sorts of delays you may encounter with managed care. Some plans are notorious about keeping members waiting to see a doctor. Ask a doctor you intend to visit how long a typical wait is before you choose a plan.
- Shop around. Call several agents and compare policies and premiums.
- Look into other potential sources for health insurance. Alumni associations, professional groups, fraternal organizations and other associations often offer health coverage to their members.