<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1200425829968335&amp;ev=PageView&amp;noscript=1">

Protecting What Matters Most


7 Tips for Physicians to Determine the Best Individual Health Insurance Plan

It doesn’t matter if you have been in business for 3 years or 30 years, as a successful Texas physician, it’s important to have a health insurance plan for yourself and your family.

However, finding the right health insurance is a balancing act between cost and coverage. How much coverage you get is determined by how much you want to pay in premiums. Figuring out which health insurance plan works best for you requires research. You have to take the time and call different insurance companies, scour the Internet for help and ask friends for advice. All of this research is labor-intensive, and you just don’t have time for it - especially when you have patients to care for.

As a physician you know how health plans work; there are premiums, in-network and out-of-network doctors and out of pocket costs. However, there seems to be some uncertainty when buying health insurance. Questions come up such as, “What level of coverage do I need?” “What insurance company should I go with?” - and so many others.

To answer some of these questions, we’ve created a checklist of questions we see most often from physicians concerning finding the right individual health insurance. 

7 Tips to Help You Choose the Right Health Insurance: 

  1. What’s my coverage priority – It’s not possible to know how much coverage you are going to need for your future.  But if you make frequent trips to the doctor, having a low deductible and lower copays is a good option. But if you are healthy and rarely make use of healthcare services a high deductible plan may be suited for you.

          As a refresher, here are the differences between HMOs and PPOs: 

  • Gives you access to a certain amount of doctors within a networkz
  • Requires you to have a primary care physicianz
  • If your doctor is not in network, there is no coveragez
  • Premiums are usually lower and sometimes there is no deductible
  • Flexibility when picking a doctor
  • You can see a specialist whenever you want
  • If you see a doctor not in your network, a percentage of the visit will be covered
  • Premiums are higher and there is usually a deductible

    As the Wall Street Journal reports, when explaining all the difference between an HMO and PPO, “it’s customary for a PPO to cover 70% of out-of-network visits”. With the widest selection of doctors and a large coverage percentage, many individuals are using PPOs. However, it’s important to go through each plan and see exactly what works for you and your family.
  1. What is my total cost - In a survey by The Commonwealth Fund, it was found that Americans allocate a considerable amount of their budget to health insurance premiums, particularly those with individual plans. An estimated 14 million people reportedly spent 10% of their income on premiums

    Unfortunately, it doesn’t matter whether you use your insurance or not, you still have to pay insurance premiums. When considering what your total cost will be for your health insurance, you not only have to factor in your premiums, but also your out of pocket costs for copays and deductibles. So take a minute and calculate the amount of times you have been to the doctor in the last year and any prescriptions you take. This can give you a good idea as to where you might stand when it comes to cost.

  1. Is preventative care covered? – Preventative care is a huge need for both singles and families alike. Since the Affordable Care Act was enacted in March 2010, everybody gains access to screenings for a variety of conditions such as diabetes, cholesterol, depression, STDs and more. That means yearly checkups for you and your family is covered. This even holds true for children.

  1. Can I keep my doctor? – This is one of the top questions from those looking to get individual health insurance. It’s a hassle to get a new doctor, especially if you have been using the same one for a number of years.

  1. What about my dependents? – This of course is important if you have children, or you are planning on having children. Most plans will charge a percentage for your children’s health insurance.

  1. How can I find a reputable company? – With a plethora of insurance companies out there, you want to choose carefully. While it might be inviting to choose the company that offers the cheapest coverage, it may not be the best choice. Even though you may trust your friend’s reviews of their health plan, it may not be right for you. Luckily, you can rate many insurance companies quickly by using websites such as A.M. Best, and Fitch Ratings. These sites will rate each insurance company to help in your decision-making process.

  1. Are my prescriptions covered? – Good question, some aren’t. So make sure to look into your plan’s prescription index and check to see if your medication is there.  If it’s not, talk to your doctor and ask him or her to explain the medical need to your insurance provider. Prescriptions can cost hundreds if not thousands of dollars without insurance.

Even with all these tools and tips, choosing the right individual health insurance plan could be time-consuming. Reach out to us for assistance in obtaining a health insurance quote. 


Speak with a TMA Insurance Trust Advisor:

Newsletter signup to receive our monthly newsletter