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Health Care & Insurance

New Rules, Resources Make It Easier to Find Individual Health Insurance

Take advantage of new consumer tools to find affordable policies.

Unless a Supreme Court decision derails the 2010 health-care-reform law, the marketplace for individual health insurance is scheduled to change drastically in 2014—when policies will be sold on state-run exchanges and insurers will no longer be able to deny you coverage or charge higher rates because of your health. Until then, take advantage of new rules and resources to help you find coverage.

Resources. A new tool at the government’s HealthCare.gov site provides extensive information about the policies available in your area and makes it easy to narrow your search based on the size of the deductible, out-of-pocket expenses and the type of plan (such as HMO or PPO). You’ll see details about benefits, co-payment rates, exclusions and base premiums.

For premium information based on your medical condition, go to eHealthInsurance.com, which queries you about your health and lists prices and policy details from many companies. You can also get help from a health insurance agent through www.nahu.org.

If you have the option of continuing coverage through COBRA—the federal law that requires employers to offer coverage for up to 18 months after you leave your job—shop around before you take it. If you’re healthy, you may find a better deal on your own.

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Adult children can now remain on their parents’ policies until age 26 if they don’t have coverage through their own jobs. That can be a great deal if you have family coverage for younger siblings and wouldn’t need to pay extra to add a grown kid. But if you’d have to switch from coverage for a single or a couple to family coverage, compare the extra cost with the price of buying a separate individual policy—healthy people in their early twenties can generally get a high-deductible policy for $100 per month or less.

High-deductible plans. The money you save in premiums may more than make up for a higher deductible. And new laws now require most insurers to provide preventive-care screenings without charging deductibles or co-payments, even if you have a high-deductible policy. Depending on your age, you could be eligible for blood-pressure, diabetes and cholesterol tests, mammograms and colonoscopies, flu shots, routine vaccines, well-baby and well-child visits, and other preventive services without any out-of-pocket costs (see www.healthcare.gov/prevention for a list of eli­gible services).

If your health insurance policy has a deductible of at least $1,200 for individual coverage (or $2,400 for family coverage), you can make tax-deductible contributions up to $3,100 ($6,250 for family coverage) to a health savings account for 2012, plus $1,000 if you’re 55 or older. That gives you a stash of tax-free money to use for medical expenses in any year.

If you have a preexisting health condition. You’ll usually be able to keep coverage from a former employer for up to 18 months under COBRA, no matter how poor your health is. Most states must provide a continuation policy after you’ve used up your coverage (see www.coverageforall.org for your state’s rules).

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If you aren’t eligible for COBRA, you may be able to find coverage through the new Pre-Existing Condition Insurance Plan, which was introduced as part of the health-care-reform law. The federal government runs the plans in 23 states and the District of Columbia; 27 states run their own plans, which must also follow the federal rules. However, there’s a big catch: You can qualify for this coverage only if you’ve been uninsured for at least six months.

Even if you haven’t gone that long without insurance, you may still qualify for a policy through your state’s high-risk insurance pool, which may not require a six-month waiting period. For a list of options and rules, see www.healthcare.gov or www.coverageforall.org.