What should consumers know about individual health plans?


Quick Answer

Some things that consumers should know about individual health plans are what exactly the plan covers, how much it costs and what providers consumers can use. Health insurance allows participants to reduce medical costs by sharing the risks with other plan members, explains ConsumerReports.com.

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Full Answer

Most insurance plans cover 10 essential health benefits, according to ConsumerReports.com. These include emergency room visits, prescription drugs, maternity care and rehabilitation services. However, plans under some large corporations or health plans wherein enrollment took place before the Affordable Healthcare Act may not provide all 10 benefits. Anyone with an existing policy interested in enrolling in a new policy should speak with an HR or healthcare representative to find out exactly what is covered.

The actual cost of an individual health plan is more than just the monthly premium. Almost all plans have out-of-pocket costs, such as deductibles and co-pays. For example, a plan may pay all but $25 of an office visit, which means that the policyholder is responsible for the $25. Read through policy details carefully to know what all of the out-of-pocket expenses are.

Some types of insurance allow an insured person to choose any doctor he wants to. Other plans, however, have a specific list of healthcare providers, called a network, and the person must choose physicians from that list. Other plans allow a person to see someone outside of the network at an increased cost. Seeing a doctor not in the network could result in the insurance company refusing to pay the bill, so double check any potential plan to understand the options.

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