Buying Health Insurance on Your Own

If you work for yourself, retire before Medicare kicks in, or don't have health insurance through your job, it often comes as a rude awakening to look for insurance on your own -- especially if you've been spoiled of years of relatively carefree coverage through your employer. Finding coverage on your own will get a lot easier in 2014 as a result of the Affordable Care Act. The uninsured will be able to buy a policy through state health insurance exchanges, and insurers will no longer be able to reject people because of pre-existing conditions. But even before that happens, most people can still find coverage on their own.

A buyer's guide

The strategies for finding health insurance on your own will continue to vary a lot from state to state, until the bulk of federal health-care reform laws take effect in 2014. But you have to start somewhere, so follow these steps. Depending on where you live, they may lead you to a dead end -- or to a far better deal than you have now.

Go online. When you shop for a policy on your own, eHealthInsurance is a great resource. It's the closest thing you'll find to a nationwide marketplace for health-insurance policies, and it lets you compare a number of options. If you'd prefer to work with someone in person rather than online, you can use a local health-insurance broker.

Subscribe to Kiplinger’s Personal Finance

Be a smarter, better informed investor.

Save up to 74%

Sign up for Kiplinger’s Free E-Newsletters

Profit and prosper with the best of expert advice on investing, taxes, retirement, personal finance and more - straight to your e-mail.

Profit and prosper with the best of expert advice - straight to your e-mail.

Sign up

Use a health-insurance broker who knows your market. Brokers not only will help you shop for price, they'll also know if a company has a reputation for raising premiums or hassling policyholders who file claims. If necessary, a broker can find a group for you to join or help you sign up for your state's high-risk pool. The National Association of Health Underwriters can also put you in touch with member agents in your area.

Visit your state insurance department's Web site. You'll probably find a list of companies selling individual coverage in your state, including those that aren't handled by brokers. For example, many BlueCross/BlueShield plans -- often one of the few choices available in highly restrictive states -- prefer to deal directly with customers, or offer such low commissions that they aren't worth a broker's time. The insurance department may provide shopping tips for your state, as well as insurance-company complaint records. (See the National Association of Insurance Commissioners Web site for links to your state insurance regulator.)

Look into your state's insurance pool. If you have a medical condition and can't qualify for a health insurance policy on your own, you may be able to get coverage from a high-risk pool. The health-care reform law appropriated $5 billion for high-risk pools, so the coverage may be a better deal than it had been in the past. Go to www.coverageforall.org to find out about the eligibility requirements, costs and coverage in your state.

If you're losing employer coverage and have a medical condition, then you can still get coverage through the Health Insurance Portability and Accountability Act of 1996. HIPAA requires that states provide some kind of coverage after you leave your job -- regardless of your health -- as long as you had an eligible policy and haven't been without coverage for more than 63 days in the preceding 18 months. You generally have to exhaust your COBRA coverage first. The Georgetown University Health Policy Institute publishes consumer guides for each state at www.healthinsuranceinfo.net.

Consider taking advantage of federal COBRA legislation if you have left a company that provided group coverage. If your previous employer has 20 or more employees, the company is required by law to let you continue your group coverage for up to 18 months. Some states have similar laws for smaller employers. You generally foot the entire bill yourself, plus up to 2% in administrative charges, which can increase your costs considerably.

COBRA coverage tends to be a good deal if you're in poor health or in a market with few choices, or you want to stick with your current doctors. But because group plans often have more bells and whistles than you'd buy yourself, you might find a better deal by shopping on your own.

Join an association that has group coverage. Look into coverage through established trade associations, but avoid groups created just to sell insurance. Their initial low premiums could jump in the future.

Look into health savings accounts. HSAs permit people with high-deductible health insurance policies to set aside tax-deductible money in an account that they can use tax-free for out-of-pocket medical expenses in any year. See FAQs About Health Savings Accounts for details.