How to Get Health Care If Your Company Doesn't Provide It

Getting Health Care As an Independent

While I was in college I was diagnosed with Syrinx a life-long condition…nothing serious, dangerous, life-threatening, painful, I didn’t even need to be on medication for it. But, when I was an entrepreneur trying to get individual health insurance, is when I realized the true cost of my condition. Since I wasn’t on a group insurance and I had a pre-exisiting condition, I couldn’t get health insurance anywhere. I tried several avenues on getting insurance and all were nearly impossible. Needless to say, I spent many hours trying to understand this complex system. I have helped many coworkers and people shuffle through the daunting options.

Three Things To Consider When Looking For Health Insurance

Here are some things I learned you should consider when your company doesn’t provide health insurance, or if you are an entrepreneur, an independent contractor looking for independent insurance.

1. Do You have a Pre-existing Condition?

If the answer is yes, you are going to have a long road to travel, like I did. Contact an insurance broker in your state before you apply and tell them the situation. The last thing you want is to be rejected by the wrong insurance provider’s underwriting department and then have that mark on your record and no be qualified for insurance at all. If the answer is no, you can simply look up on health insurance websites such as blue cross blue shield and compare the coverages.

2. What Kind of Plan Do You Want?

When you are looking on your own, you are going to see way more plan options than if you are an employee. An office tends to give you two options, but you have hundreds. It pays to know the difference. HMO means that you are going to be required to have a primary care provider that will refer you to any specialist you need to see. Your plan will not be flexible in paying for out-of-network treatment, but you will have lower out-of-pocket costs. PPO means that you have a network, but your plan is a little more flexible in paying for part of the treatments you may need outside your network. For that flexibility, though, you will tend to pay more out-of-pocket.

3. What Kind of Deductible Plan Do You Need?

Monthly costs can be deceiving! Don’t just go for the cheapest monthly, because you might end up paying way more in the long run. Think about your medical needs when you are considering your deductible, coinsurance, and office visit cost.

For the deductible, consider this: if something bad happened to me how much could I afford to just shell out. A lot of times young people make the mistake and think nothing bad could possibly happen and therefore they should just save money monthly and get a high deductible plan. But the truth is things happen, and if they do, can you afford to pay $8,000?

Coinsurance, in this case, you want to minimize it as much as possible. Coinsurance is the percentage of the bill you pay AFTER you have exceeded your deductible. That means that if you have already paid out your $8,000, you might still have to foot 50% of the rest of the bill, if you have a 50% coinsurance. (There is an annual limit though.)

Finally, office visits: the higher your cost per visit, the cheaper your monthly premium will be. Determine this part of the plan based on your habits: do you do a lot of check-ups or do you rarely see the doc? In my opinion, though, your best bet is to go with a flat fee ($20 or $25) instead of a percentage. Office visits can get really pricey, and when you are paying 50% after deductible (that means you are paying 100% before you reach your deductible) the bill gets steep fast.

Getting Health Care Coverage

At the end of the day, for me and my “pre-esisting condition,” I was unable to get individual insurance all together. Fortunately, I was able to get back on my family’s insurance. However, if you are able to get insurance individually, you are going to be faced with a lot of options. I really recommend not just going with the cheapest option. Insurance is set up to help you when you need it the most, usually those needs are unpredictable and generally very costly. So don’t go broke trying to save money. Now I have fixed prices on my office visits, since I go frequently for MRIs, ultrasounds, and other check-ups, this was imperative. To lower my monthly premium, I gave up my flexibility and joined an HMO plan. And. I made sure I picked a reasonable deductible that I would be able to pay at any time.