A Roadmap to Choosing Individual Health Insurance

When it comes to their health, each person and each family is unique, so it is not surprising that choosing an individual health insurance plan is a complex process. Cost, convenience, and your unique health issues all come into play. Somehow, out of the myriad of choices, you are supposed to find the right combination for you. Here is a roadmap to simplify the process:

1. Start at affordability. It is easy to think insurance should cover every need and contingency. Remember, it is there to keep you from going into debt, not to put you in debt. Set a budget that makes sense and do the best you can within that framework.

2. Proceed to your existing physician. If you have a good relationship with your current doctor and want to continue seeing him or her, your choices may be limited for individual health insurance. Find out if your doctor is affiliated with an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service), or IPA (Individual Practice Association). If your doctor is in one network, then your decision is simple. If he or she is in more than one, you can weight other plan features. If your doctor is not in any network, you will need a "fee-for-service" or indemnity plan. Under this plan, you go to any doctor or hospital you wish. An indemnity plan normally will cover only a percentage of the changes-usually 80 percent. You are responsible for the other 20 percent. The insurance company also sets its own "usual and customary" rates for services. If your doctor charges more than the usual and customary rate, you will have to make up the difference.