Individual health insurance is an individual plan bought by an individual that fills a special need. Most Americans get their health insurance through their employer-sponsored group insurance. However, those who are unemployed, self-employed, work only part time, are not working for an employer who offers health benefits, or work for an organization that does not offer health care are often on their own to get an individual health insurance plan. Buying individual health insurance is an individual decision depending on your individual health care needs and financial capability. Individual health care insurance differs from group insurance in the way the insurer decides what to pay for and under what conditions.
Most individual health insurance plans include a choice of deductibles and premiums. Deductible is the amount you have to pay in the event that you meet with an accident or a disease, before the insurer pays anything. With higher deductibles, the monthly premium is also lower. However, the total cost of your monthly premium and the actual deductible may vary depending on your age, health history, family medical history, and current health condition.
One of the most common types of individual health insurance plans are the PPOs or preferred provider organizations. A PPO plan provides coverage that is similar to traditional health plans. For most Americans, this type of coverage is less costly and covers the most basic medical costs. Some PPO plans have limits to the medical costs covered and there are often co-payments to be made for each doctor visit.
Another popular type of individual health insurance plans are prescription drug plans. Prescription drugs are one of the most expensive medical expenses. Some prescription drug plans cover the cost only for the few prescriptions a person needs every year. Other prescription drug plans require a person to take an inventory of the number and kinds of prescription drugs they take and submit to the company. Then, the company calculates the maximum amount it will cover for each prescription drug.
Each state has its own individual health insurance plans. Each state health insurance marketplaces have different rules and regulations. The rates and premiums for individual health insurance plans, according to each state’s marketplace, may vary widely from one state to another. Some states, such as Illinois, cap the amount an employee can contribute to their coverage. Other states allow employers to choose their employees’ health care coverage, while some only provide a limited choice among the options available to them.
There are also group insurance policies. The most common type of group insurance plan to pay for the medical expenses of the members of the group. Most group health care plans require employees to choose their own prescription drugs and medical coverage. Some companies have both health care benefits and prescription drugs as part of their insurance benefits. Some plans only cover a specified number of prescriptions, while other plans offer a wide variety of choices in prescription drugs. And, there are even some companies that provide no prescription drugs coverage at all.
In order to get full or partial reimbursement for eligible medical expenses, an individual who owns a health plan must meet certain income requirements. Income requirements usually range between fifty and eight hundred per cent of the eligible monthly income of the family, if the family does not consist of dependent children. Some insurance companies have different income requirements. Each month, the eligible medical expenses must be submitted to the insurer. At the end of the open enrollment period, the insurer will decide whether to grant full or partial reimbursement.
Subsidies from the federal government and certain private health plans are available to individuals with income less than the applicable threshold. For example, the federal Medicaid program has subsidies for low income families. Similarly, the State Health Insurance Pool (SIP) provides cost-sharing subsidies to individuals who have no medical coverage. In addition, some insurers provide additional income less insurance subsidies if the individual purchases a Health Savings Account (HSA).