Comparing Private Insurance Options
Obtaining health insurance for yourself and your family is important but not always easy. This section describes how to evaluate your options within the Individual Health Insurance market. Individual Health Insurance is the primary choice for individuals not covered by employer- provided insurance or public programs. While a majority of Americans obtain coverage through group health plans offered through their employers, many employers have downsized in today's weak economy and others are dropping coverage as health insurance premiums increase. Consequently, the demand for Individual Health Insurance is growing.
Individual Health Insurance differs significantly from the Group Market. Over the age of 19, applicants can be denied today due to pre-existing conditions (will be prohibited as of January 1, 2014). Costs vary widely by health plan, by age and other factors. Health insurance companies offer many different plans which vary in the scope of benefits, cost and choice of provider(s). Evaluating and choosing coverage in the Individual market can be very complex and this section provides guidelines and tools for making your selection.
At a Glance
Currently, access to individual health insurance in California depends on the health status of applicants who are 19 and older. Individuals (except children) may be denied coverage, charged a higher premium, or have certain pre-existing conditions excluded from coverage for a period of time. This will change in 2014 when several of the provisions of the Affordable Care Act are fully implemented.
Health plans are complex, with so many details that it can be difficult to focus on the issues that are most important. Generally speaking, you should evaluate and compare plans on three dimensions: benefits, choice, and cost.[i]
You'll want to make sure the plan benefits include the services most important to you and your family. Also keep in mind that, typically, the more that is covered, the more the plan will cost.
There are several different types of health plans available to individuals and families. For example, managed care plans (HMOs and PPOs) typically limit participants to a network of providers, and charge more if participants visit providers outside the network. You will want to know the physicians and hospitals that are considered “in network.” Catastrophic coverage health plans usually cover a more limited scope of benefits for emergency services, with higher deductibles and often lower premiums. The California Department of Insurance offers an interactive checklist to use to understand and compare health plans. Go to the California Department of Insurance Interactive Checklist.
Besides the monthly premium, most plans require "cost-sharing," in which participants may have to spend the deductible before the insurance pays the costs, pay a fee at the time of service (a copayment) or pay a percentage of the total cost (called co-insurance). You can compare pricing and benefit information for individual policies available in your area in a number of ways:
- Use the Health and Human Services’ Insurance Finder tool.
The Health Insurance Finder is a tool that was created under the ACA to help individuals, families and small businesses find health insurance. This web-based tool asks you to respond to a number of questions and then it uses your answers to compile a list of private insurance and public programs available in your area that are best suited to your needs.
- Contact a licensed insurance broker. Be sure to use the License Name Search offered by the California Department of Insurance to find out if a broker is licensed and to see a list of the companies they are authorized to represent.
- Search for privately funded internet resources such as e health insurance.
For information about Public Programs, go to the section on this website entitled, Public Programs.
Note: If you feel that you have been denied coverage or services inappropriately, the San Diego Consumer Center for Health Education and Advocacy (CCHEA) is available to help you resolve your problem. Call 1-877-734-3258 for assistance.
[i] California HealthCare Foundation, . (n.d.). Health coverage guide - evaluating plans: part 1 - getting started. Retrieved from http://www.healthcoverageguide.org/guidepartone/how-to-evaluate-plans.aspx