SUNDAY, Oct. 23, 2005 (HealthDay News) -- If you're unemployed or self-employed or if you work for a small business that doesn't offer health insurance benefits, buying a health plan on your own may seem prohibitively expensive.
But it's worth investigating the options in your state, insurance brokers say.
"It's always better to be covered for something than nothing," said Thomas H. Harte, president of Landmark Benefits in Hampstead, N.H.
The cost may depend on what a person is looking for, he said. There are a number of variables to consider, including the monthly premium you'll pay, co-payments you'll incur on services and drugs, and the types of benefits a plan will cover.
Premiums vary from state to state and may hinge on the type of insurance market reforms a state has implemented, explained Harte, who serves on the National Association of Health Underwriters' legislative council. In New Hampshire, for example, a healthy person will pay less than a comparable individual in Massachusetts. The difference is that New Hampshire allows insurers to adjust premiums based on an individual's health status and use of health services, while Massachusetts does not, he said.
Premiums are generally higher in the New England and Mid-Atlantic regions of the country, according to a report by the Henry J. Kaiser Family Foundation and eHealthInsurance.com, an online health insurance referral site.
Nationally, the report said, older purchasers generally pay higher premiums than younger purchasers, reflecting the higher health-care costs that people typically incur as they get older.
In addition to premiums, individual health insurer buyers should consider their out-of-pocket exposure. Deductibles for single and family policies vary widely, from less than $500 to more than $3,000, the Kaiser/eHealthInsurance report showed. Co-payments for physician office visits differ, too. About one half of single purchasers choose plans with co-payments of less than $20, the report said.
Consumers also need to learn about any exclusions and limitations that may affect their out-of-pocket costs, Harte advised. A health plan with a generic drugs-only policy, for example, may be a poor fit for a person who takes a brand-name medication with no generic equivalent. He or she may qualify to receive the insurer's negotiated discount at the pharmacy counter, but the money to pay for that medicine would come from the health plan member's own pocket.
Individuals who are willing to assume risk for routine medical expenses in order to lower their health insurance premium might want to consider a "high-deductible health plan." With the exception of some preventive care services, these plans don't begin paying for medical care until the policyholder has met a higher-than-usual deductible.
"You have to talk to your insurance broker or agent to determine if it will be a cost-effective decision for you," Harte noted.
Then comes the application process. Whether you are seeking insurance for yourself or your family, you'll need to complete the insurer's health questionnaire, which will ask about your use of medical services say, over the past year, as well as your medical history.
It's in your best interest to answer truthfully, Harte advised. If you don't, your insurer may terminate your policy retroactively or boost your premium.
As a safeguard, more than half of all states have high-risk pools to insure individuals who are denied private coverage, according to the National Conference of State Legislatures. These pools typically offer coverage similar to what's available through private insurers, but it's always more expensive.
More information
Visit the National Association of Health Underwriters for tips on buying health insurance.
