Hunting for Health Insurance? Do Your Research


By Tom Murphy, AP Business Writer

INDIANAPOLIS (AP) — The new health care law promises help for people who cannot rely on an employer-based plan to cover their insurance needs. But that doesn't start until 2014, and millions are expected to need individual plans in the meantime.

Many should be able to find what they need by doing some research, asking the right questions about coverage and using some government help that's already available. Here are basic steps to take before choosing a plan:

Think about your needs.

Consumers can't find a policy that suits them unless they understand what they need. If you see the doctor frequently, a plan that limits those visits to four times a year would not be wise. But that could be an option someone in his 20s who rarely gets sick.

Likewise, a plan that doesn't cover pregnancy wouldn't be smart for people who want to start families. Some options only cover generic drugs, and that means big pharmacy bills for someone who depends on a brand-name prescription medication.

"Once you can identify what the health insurance needs are . that will kind of dictate what your monthly premium will be," said Keith Mendonsa, a consumer health insurance specialist with eHealthInsurance, an online insurance broker.

Before searching for insurance, think about whether you can be added as a dependent to the existing coverage of a spouse or parent.

Do some research.

Premiums, or the price of an insurance policy, vary widely depending on variables such as age, health, where you live and how you want your coverage set up. One place to start sorting options is, which is managed by the Department of Health and Human Services.

The site walks consumers through plan design, helping them find coverage options based on their states and other factors that could affect their rates. It was put together by people who "care about actually being useful to consumers," said Nancy Metcalf, a senior program editor with Consumer Reports who is not involved with the site.

"All of the policies you are going to see are going to be decent policies, and they'll also say if some stuff isn't covered," she said.

Consider a broker.

Licensed insurance brokers can help customers quickly sort through their options, and they can be especially useful for people who have pre-existing conditions. For people with diabetes or recovering from cancer, finding individual coverage can be difficult or impossible depending on the state in which they live.

Some people also can be turned down because they take high-blood pressure or cholesterol medicine or they recently had hip surgery, Metcalf said. Brokers know which insurers will reject certain conditions, which can save some grief.

Look closely at coverage details.

Most policies contain a summary of key numbers. Consumers should examine at least five: the premium, deductible, co-payment, coinsurance and the maximum amount the policyholder can expect to pay out of pocket each year.

The deductible is the annual amount a patient pays for care before coverage starts. High-deductible plans come with lower premiums.
Coinsurance is the percentage a patient pays for medical care generally after a deductible is met. These percentages mean you still could wind up with a big bill for a surgery even if you have good coverage and you've met your deductible.

The annual maximum is how much you have to spend on coinsurance and other costs before the insurer takes over and covers the majority of your remaining expenses for the year.

"This is your maximum financial exposure, and it's a big deal," Mendonsa said.

Be careful.

Make sure you understand all the coverage specifications before you pay for a policy. You also should know if your doctors are in the insurer's network because it will cost a lot more for care and visits if they are not.

It also pays to understand hospital coverage and the limits a plan places on it.

"You don't want to be blindsided," Metcalf said.

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