Choosing independent health insurance during 'the gap'

 

1. Confirm you are not still covered. “First and foremost, depending on your permanent state residence, you may still have time left on your parent’s employer plan. State mandates require that dependants are still eligible for their parents plan up to a specific age. These ages vary by state. Most states have adopted 24- to 26-years-old as an acceptable dependant limit,” said Eric S. Avrumson, a benefit consultant at Willis HRH.

 

2. Check your COBRA qualifications. “If you have been previously insured under a parent’s group health plan, you might not be kicked off yet. You may be able to buy yourself some extra time on your parent’s plan under the federal COBRA law. COBRA says that a ‘loss of dependent child status’ makes you eligible to stay on your parent’s plan for up to 36 more months, except you’ll have to pay the full premiums plus a two percent administrative fee,” Amy Danise, editor of Insure.com.

 

3. Take a look at yourself. “Before comparing plans, the first step should be to evaluate yourself and your potential health needs. Do you have any chronic ongoing conditions that require treatment on a regular basis? Do you take prescription medications that you need to have filled every month?” said Matthew J. McDermott, SPHR, an employee benefits consultant at Landmark Group of Brighton, Inc. “If the answer to these questions is yes, then you may want to focus on plans with lower deductibles that include prescription coverage and specialist visits at a lower co-payment. If the answer is no, then you should focus more on plans with a higher deductible, but that protects you against unexpected illnesses or injuries, sometimes called catastrophic coverage.”

 

4. Determine the length of your need. “You also want to ask yourself, how long are you going to need the coverage for? If you have a job lined up, you’ll want to know when your new employer’s coverage kicks in. It’s rare, although not unheard of, for coverage to start on the date of hire. Frequently, new hires have to wait anywhere from 30 to 90 days before becoming eligible to enroll in an employer’s plan. If you’re still in the job market, you may need to keep this coverage for a while, so don’t lock yourself into a plan that becomes unaffordable,” said McDermott.

 

5. Find an insurance agent. “Find a local insurance agent who has experience in the individual health insurance market place. Look for an agent who works with all the major individual health insurance carriers,” said Timothy P. Tracy Jr., vice president of Gerard B. Tracy Associates. “A good place to find a reputable agent in your area is through the National Association of Health Underwriters. An insurance professional would be able to work directly with an individual to help analyze their specific needs and provide guidance and assistance while enrolling in an individual health insurance plan.”

 

6. Check the maximum out-of-pocket. “This is the dollar amount that reflects the most you would have to pay in a calendar year on your medical expenses. It is the combination of your deductible and coinsurance limit. This is very important to pay attention to and can differ greatly between plans. You should pick an out-of-pocket maximum you can afford should anything happen that would drive you to reach that maximum,” said Tracy.

 

7. Choose a network that suits you - in-network only or in- and out-of-network. “With an in-network only plan, also known as a HMO (Health Maintenance Organizations) or EPO (Exclusive Provider Organization), you have to use doctors or facilities that participate in that network. If you go to a non-participating provider, you could be responsible for 100 percent of the cost,” said Tracy. “An in- and out-of-network plan, also known as a PPO (Preferred Provider Organization) or POS (Point Of Service), normally has a larger network of doctors and facilities and also provides you with the ability to see any provider of your choice, even if they don’t participate in the network and still receive coverage.”

 

8. Check to see if your doctors are participating providers. “If you have a strong relationship with your existing primary care physician (PCP), you will want to find out what plans your doctor accepts. Some plans require that your PCP coordinate all your care, meaning that you will need a referral from your PCP before visiting a specialist like a dermatologist or optometrist,” said Frank McCauley, head of Aetna's Consumer Business Segment.

 

Tracy adds, “Every insurance carrier has a Web site that allows you to run a quick search to see if your doctor is a participating provider. You can do this yourself or have the insurance agent do it for you.”

 

9. Check for drug coverage. “Prescription coverage is not always included on every individual health insurance plan, so if you want coverage for prescription drugs, make sure you are looking at a plan that covers it. Prescription coverage differs by insurance carrier and policy, so make sure to ask questions on how prescription drugs are covered under each plan,” said Tracy.

 

10. Look for things that are not covered. “Ask your insurance agent what is exclude in each plan so that there are no surprises,” said Tracy.

 

11. Research the provider’s background. “When evaluating any insurance policy, you should check the financial backing of the company and the provider network. You want to make sure the carrier is in business for the long haul and not a fly-by-night company,” said Reese McFaddin, owner of Workplace Benefits.