What happens if group health insurance plan in not available to you?

Answer 1

There are a few options:

1. Through a licensed health insurance agent, apply for an individual health policy. These are medically underwritten, meaning that your medical history is taken into account in determining whether or not to issue a policy and the premium that is charged. They tend to be more costly than group policies. This is because the insurer does not have the benefit of "the law of large numbers", meaning that the insurer cannot spread the risk of losses over the entire group.

2. You can join a managed care entity, such as a health maintenance organization (HMO). Often, HMOs are seen as providing a lesser quality of care. However, many are very good. A misunderstanding arises because the care delivery model is different from what is customarily viewed as health insurance. Instead, a member's care is managed by a primary care physician who provides day to day care, with an emphasis on preventative care. A referral is usually needed from the primary care physician to see a specialist.

It is critical, whether you are considering #1 or #2 above, that you deal only with a licensed entity. Both kinds of entities are regulated by state insurance departments in the states in which they operate. The regulation pertains to financial stability, premiums charged, and the language of the policy contract that is used. Always check with the department of insurance to ensure that the company is a real insurer (or HMO) and authorized to conduct business in the state.

3. Another alternative is a medical discount plan. This is not insurance, because the plan does not assume the obligation of paying the cost of your medical care. Instead, the plan contracts with hospitals and physicians to provide care to members at a fee that is less than that normally charged. Payment remains the member's responsibility. The amount paid to the plan is merely for access to the participating providers. With these plans, it is important to ensure that the physicians that you use are members of the plan, because if they are not, you will not get the plan discount. Also, providers come and go from the plans, so participation can change.

4. Finally, it is often possible to work out discounts or payment plans directly with providers.