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?There's strength in numbers, particularly when you're buying health insurance. As part of a group plan, you can enjoy a significant discount on premiums as well as comprehensive policies. But if you leave that job or start another one that doesn't offer health insurance you may be surprised at just how expensive the same coverage is when you buy individual health insurance. ("Individual" means the insurance is not connected to a business or to the self-employed. You can purchase an "individual" policy that covers your whole family.)

In addition, there is no guarantee that an insurer will take you on. Individual plans are medically underwritten and the insurer may reject your application or attach exclusions to your policy if you have health problems. However, some states don't allow this practice and require that any insurer selling individual health plans must offer you a policy, no matter what medical problems you have. This kind of law is called "guaranteed issue."

However, your premiums are still likely to be substantially higher. People enrolled in individual plans pay premiums more in line with their expected health costs, so the premiums will be higher for those who are older or less healthy. To find out what your rights are, contact your state insurance department.

Pricing is probably the most bewildering aspect of individual health policies, so it's worth your while to shop around. For instance, the premiums for similar products from different insurers can vary by as much as 50 percent for the same person. What's more, the rules and regulations about individual health insurance vary from state to state, making comparison-shopping difficult.

If you're faced with finding individual health insurance, don't let the confusion tempt you to go without. Even if you're healthy, you could fall off a ladder or have a serious car accident and be financially ruined. Plus, you'll lose your pre-existing-conditions coverage in most states if you go without insurance for more than 63 days, an interval set by the Health Insurance Portability and Accountability Act (HIPAA).

Finding the right balance of coverage and cost can be challenging, but it's a necessity. So take your search one step at a time. The first step is to evaluate your needs and understand your health insurance options. For some, that may mean buying COBRA coverage from your former employer.

When you leave a job, you don't necessarily need to leave your health insurance behind. Thanks to COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985), certain employers that provide a group health insurance plan must offer most employees who would lose their coverage the option to continue it for up to 18 months. The catch is that the employee will have to pay the full premium, up to 102 percent of the employer's cost. (The extra 2 percent is an administrative fee.)

COBRA is best seen as a safety net. You have 60 days to make a decision about whether to enroll in COBRA, and when you do, the coverage is retroactive. As soon as you know you will be losing your group coverage, start shopping for individual coverage. Go out and talk to independent agents who represent different companies. If you find a policy you like, apply for it. You should be able to find out if you are accepted within those 60 days. If you find a less expensive policy that meets your needs, buy it. If not, you can still elect COBRA.

COBRA covers all members of your family, so if you find an individual policy that works for you but won't cover your wife's pre-existing illness, go with COBRA only for her.

A pre-existing condition will make finding individual health coverage more complicated ? and more pricey ? but that shouldn't knock you out of the race completely. HIPAA restricts the ability of insurers to exclude pre-existing medical conditions from coverage but only if you were previously part of a group plan and meet certain other strict requirements.

COBRA aside, the individual health insurance market is a wild frontier. The landscape varies from state to state and the rules are constantly evolving. That's why it's imperative to compare multiple companies when you shop. An independent agent well-versed in individual health policies can help you sort through your options and find the policy that's right for you and your family.

Among your choices, you'll find that the individual health market offers the same plans as the group market, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service (POS) plans, and traditional fee-for-service arrangements. For explanations of these terms, see Health insurance basics. Your budget, physician preferences, and health requirements will all have a hand in deciding which type of plan is best for you.

There are five types of health plans available in the marketplace.

1. Traditional Indemnity
People who want pure freedom in the selection of their medical providers and who are willing to pay more for insurance may choose these plans.

Advantages:

• The plan allows an individual to choose any health care provider they wish
• They have few restrictions?

Disadvantages:

• There are no financial incentives to reduce patient financial responsibility
• The absence of cost containment features creates high premiums and employee contribution costs?
• You may be subject to Usual and Customary reductions if the health plan feels your physician charged too much

2. Health Maintenance Organization (HMO)
These plans have become very popular due to their low cost and comprehensive health insurance coverage.

Advantages:

• There are no deductibles or coinsurance expenses, only a copayment
• The cost of premiums and employee contributions are low due to the high presence of cost containment features
• Paperwork is practically eliminated for the patient as there are no claims to submit and no EOBs to receive

Disadvantages:

• You can only see a physician within the HMO network
• You must select a Primary Care Physician who acts as a "gatekeeper" to specialists
• There is a larger number of cost containment elements in the plan (authorizations, referrals, etc.)

3. Preferred Provider Organization (PPO)
These plans offer financial incentives for staying within the plan's network of physicians.? The cost of this plan is "higher than average."

Advantages:

• The plan offers financial incentives to see physicians in their preferred provider network
• Many services require the patient to pay just a copayment, such as for outpatient visits or prescriptions
• A person may continue to see a physician who is not part of the preferred provider network, but at a reduced payment and higher out of pocket cost.

Disadvantages:

• Deductibles and coinsurance do apply for many services, such as hospitalizations and out-of-network services
• Claims are submitted by the medical provider, making it important for the health plan to pay the claim correctly
• The premiums and employee contribution costs are higher than those of any HMO, but lower than a Traditional Indemnity Plan

4. Point of Service Plan (POS)
These plans are considered a hybrid of an HMO and PPO plan. The cost of this plan is slightly more expensive than an HMO Plan, but less or similarly priced to a PPO plan.

Advantages:

• Like a PPO Plan, this POS plan lets you go out of the network,?
• Your cost of going out of network, may be expensive, unless you obtain approval from your primary care physician

Disadvantages:

• Like an HMO plan, you must select an in-network physician to be your primary care physician
• If you do go out of network without a primary care physician referral, you may have to pay a higher share of the costs

5. Health Savings Account (HSA)
These plans are the next generation of Medical Savings Accounts (MSAs).? An HSA is a tax-sheltered savings account similar to an IRA, but specifically created for medical expenses and works in conjunction with a high deductible HSA eligible health insurance plan.

Advantages:

• Having an HSA with a high deductible will typically have a lower premium
• Pre-tax money is deposited each year into your HSA and can be withdrawn anytime for qualified health expenses?
• Your employer can contribute to your HSA

Disadvantages:

• The HSA is tied to the IRS Code
• If you withdraw for non-qualified medical expenses or non-medical expenses, you would pay taxes on that money

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Source: http://www.nationwide-healthcare.com/1/posts/_/67_phoenix/7022_Do_you_need_Traffic_PJC_ID_60_.html

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