Health Coverage for Individuals

Health coverage for individuals is offered through private insurers. Unlike health benefits through employer-sponsored insurance plans, health coverage for individuals is not guaranteed. Individuals must meet specific underwriting criteria to qualify for private health plans. There are a variety of plan options available to individuals. People should research which options are suitable for their individual needs.

Plan Types

• Indemnity plans and managed care plans are the primary types of health insurance plans. Managed care plans give participants a range of "network" provider options such as health maintenance organizations, point of service plans and preferred provider organizations. With managed care plans, participants must choose providers within the network for the lowest costs.

  Indemnity plans are fee for service. With these plans, participants are free to pick the doctor or hospital of their choice without provider network restrictions. These types of plans provide limited benefits but are generally less expensive than managed care alternatives. Indemnity plans include flexible spending accounts, basic and essential plans, and health savings accounts. High deductible insurance plans are typically purchased in conjunction with health savings accounts.

Choosing a Plan

• Choose a health insurance plan based on the services you and your family are most likely to use. Many individual plans are "a la carte," meaning some basic services such as doctor's visits and lab tests are included while others must be added. For example, most individual health insurance plans cover routine wellness exams but almost all plans exclude coverage for prenatal and maternity care. If you anticipate the need for maternity coverage, you should pick a plan with the option to add this coverage.

  Some individual plans only insure major medical expenses. Many require that you meet deductibles or other out of pocket costs before benefits kick in.

Insurance Costs

• Individual health insurance can be expensive. When determining the cost of your health premium, insurance companies consider factors such as age, gender and current health status. Generally, the older you are and the more treatments you require for existing health conditions, the higher your insurance premium will be.

  You can lower your insurance premium a few different ways. For example, if you are generally healthy and rarely seek medical attention, you can lower your insurance costs by only insuring against catastrophic expenses. Also, if you are part of a managed care network, only use medical professionals within the network to take advantage of provider discounts.

Considerations

• Not everyone qualifies for individual health insurance. If you suffer from a pre-existing condition, most individual health insurers will exclude the condition or deny you coverage. In this instance, you may have to obtain coverage from state-sponsored high risk insurance pools or a government sponsored health insurance program.

  The Affordable Care Act was enacted in part to provide individuals with pre-existing conditions access to affordable health care insurance despite current health status. By 2014, all private health insurers will be prohibited from discriminating against an applicant because of a pre-existing condition under the Affordable Care Act.