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Protecting What Matters Most


Building the Case for an Individual Health Insurance Plan

There have been a lot of changes in the healthcare industry over the past few years, and it’s expected to continue evolving. One of these changes is a move away from group coverage to individual health plans. These are a few common reasons why physicians may need individual health insurance coverage:

  1. Their medical practice does not offer health insurance
  2. They have started their own practice and do not need to offer group coverage yet
  3. Group coverage does not fully meet their needs

One of the most common reasons for individual health plan enrollment is working at a medical practice that does not offer group health benefits. Today, due to the recent Employer Mandate Law, companies and practices with less than 50 employees aren’t required to provide insurance to their staff. For this reason, some practices are moving towards individual coverage.

Opting for an individual plan can end up being costly if you aren’t careful. Consider these tips to make sure you understand what you are buying, and that you get the product that is best for you.

Tips for Purchasing Individual Health Insurance Without Breaking Your Bank

  1. Do your due diligence. Finding a quality health insurance company can be time consuming, but well worth it. Use the help of an online rating center like A.M. Best or Moody’s to gain insider knowledge into the credit ratings of insurers. Additionally, check the history of consumer complaints filed for the insurer.

    As a physician, you also have an advantage when it comes to looking for adequate individual insurance. Ask your accounting department to check to see which insurance companies pay quickly. This could benefit you when determining which health care provider to choose.

  1. Opt for a high deductible, low premium plan and a Health Savings Account (HSA). For many physicians, having a high deductible health plan with low premiums makes the most sense. Although you may pay more out-of-pocket costs for a doctor’s visit, you will pay lower premiums throughout the year.

    An HSA is the perfect match to offset the cost of a high deductible plan. An HSA works just like a checking account. The funds that are contributed into an HSA account can be used for medical expenses. Contribution levels range from $3,350 for singles and $6,650 for families. Advantages of an HSA are that contributions are pre-tax and unused funds roll over year after year. 

  1. Understand what you are buying. When considering individual health plans, understanding the full extent of coverage and the procedure for out-of-network care is essential. Two big questions about taking on a new individual health insurance plan are “is my doctor in the network?” and “does this new insurance cover my prescriptions?” Therefore, to make sure your doctors accept the insurance plan you are considering, call your doctors’ offices and ask. Along those same lines, many insurance companies put limits on some medications. Call the healthcare provider and ask them if you’re covered.

    It’s also critical to be aware of the provider’s policy for seeing an out-of-network doctor. As a physician, you know that not seeing an in-network doctor can definitely be expensive. In fact, some health care plans don’t cover the cost of an out-of-network doctor at all, which means you are stuck paying the bill yourself. Since all out-of-network costs and coverage depend solely on plan type, read the fine print thoroughly.  

  1. Pick a health plan that covers your needs. With the Affordable Care Act, full mental health and maternity coverage are now included in all plans. Some insurance plans are now covering fertility treatments. Bottom line, you will need to read the fine print before making a final decision on your individual health plan to ensure that your needs will be met.

As you can see, there’s a lot that goes into finding the right individual health insurance plan and provider. Having a trusted advisor to guide you through this process is always helpful, and strongly recommended if this is your first time purchasing individual health insurance. An advisor can save you time when researching insurance providers and provide you with in-depth knowledge about products and network adequacies.

Don’t have an insurance advisor yet? Feel free to reach out to us and we will partner you with an advisor who can provide guidance and answer any questions you may have.

Speak with a TMA Insurance Trust Advisor:

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