Insurance World

Deciding which individual and family health insurance plan is just right for you and your family can seem as challenging as judging which apple is the very best out of an entire barrel at the supermarket. The apples are all different sizes, shapes and colors, and the health insurance plans all offer different fees, types of benefits, and levels of coverage.

For many people, the group health insurance plan sponsored by their employer offers them the most affordable coverage. Group health insurance is exactly what it sounds like: a health insurance plan or plans offered to groups of people through their employers. Individual and family health insurance, on the other hand, is offered to individuals and families instead of employer groups, and it can be a much more attractive and affordable option than many people believe.

Because individual and family health insurance is not offered through an employer, those who choose this type of insurance will pay the entire cost of the regular premiums. However, there is a wide range of plan types available, allowing smart consumers to maximize the coverage they are receiving for the money they’re investing in the plan. In some situations, they may even be able to save money compared to what they would have spent in premiums for an employer’s group health insurance plan. Either way, consumers should never forget that the money they’re spending each month for health insurance is 100% tax-deductible.

There are two basic types of individual and family health insurance plans: indemnity and managed-care. An indemnity plan gives its policy holders more freedom to choose the source of their health care, allowing them to receive treatment where and from whom they choose. It is also likely to require them to pay out-of-pocket for the services they receive and file the paperwork themselves in order to be reimbursed. Many indemnity plans also require higher deductibles that must be met before the plan coverage will begin, and they also pay claims based on a percentage of the cost for the care. Managed-care plans, on the other hand are usually based on a network of approved health care providers from whom their policy holders can receive treatment. Because this network of providers has, in most cases, agreed to provide the treatment at a pre-set price, the care will cost less out-of-pocket for the consumer. The paperwork is generally taken care of by the health care provider instead of the policy holder, and the care is covered with only a low percentage coinsurance or set co-payment amount required from the policy holder.

There are three types of managed-care plans: HMOs, PPOs, and POS plans. These options are all based on provider networks and require their policy holders to pay for their health care depending on their tendency to seek care from in-network or out-of-network providers.

In each category, there are dozens of available plans offering different levels and types of coverage that allow users to choose based on personal needs. Many plans require a deductible amount to be met for each plan year before coverage begins, and monthly premiums are likely to be lower for plans that have higher deductibles. This along with other factors affects how much the plan will cost the consumer to use. Therefore, a person who expects to seek health care only a few times a year will likely benefit by choosing a plan with a lower monthly premium. On the other hand, those who seek routine care and have a history of more physician visits, and/or who regularly fills expensive prescriptions, can best serve their medical needs with a plan requiring a higher monthly premium and low or no deductible.

These are not the only factors that should be considered when choosing a plan. Someone who travels often may want to consider the possibility of needing to seek care while far from home and the advantages of an indemnity or a more flexible managed-care plan, so that unexpected out-of-network expenses can be covered. Women who expect to become pregnant during their plan year must carefully study the coverage offered to them during pregnancy and delivery. No plan is right for everyone; that’s part of the reason there are so many from which to choose.

Making a smart choice requires thorough study of the plans available. The needs of every person who will be covered by the plan should be taken into account. With careful consideration and planning, those needs can all be met affordably through family and individual health insurance.