Individual Health Plans Advantages and Disadvantages

Whether you are self-employed, have one or two jobs or retired, you need a good health insurance plan for yourself and your family. It is important to get good health insurance coverage against unexpected medical expenses in order to avoid to be buried in debt. However, a plan that is good for someone else may not be the right one for you. In industrialized countries like the US, where the health insurance companies constantly change their policy, it is necessary that you have adequate information before choosing a health insurance plan. This article explains the different types of health insurance, their advantages and disadvantages so that can choose wisely if you shop for health insurance.

Individual health insurance

Individual health insurance is a form of individual contract between you and an insurance company to guarantee the repayment of all or almost all medical expenses. This may includes hospitalization, medications, dental care, seeing a specialist, and certain therapies (radiotherapy, chemotherapy, etc.). This service may be provided by a government-sponsored social insurance program (mostly for individuals with low income), or from private insurance companies.

What is the history behind health insurance?

Some hundred years ago, before the appearance of health insurance, all patients used to pay their health care costs. Around 1694, Hugh the elder Chamberlen (1630-1720) introduced health insurance. At that time, the idea was not widely known and welcomed by the public. Around the end of the 19th century, health insurance took an expansion, and other forms insurance such as accidental or disability insurance started being available in certain states in the United States.

Franklin Health Insurance Company of Massachusetts was the first company to provide accident insurance in the United States. However, it covered only injuries caused by railroad and steamboat. As the insurance industry grows, in 1866, there were approximately sixty companies offering accidental insurance in the United States. Today, there are more insurance companies than we can count.

Although there are numerous insurance companies, health insurance plans are grouped into three main categories:

Fee-for-service - also known as indemnity plans is a type of insurance plan where you, patient, have to pay all medical expenses out of your own pockets, and then request a reimbursement from your insurance company. These types of plans have their advantages and disadvantages.

Advantages: they offer more flexibility in choosing your own doctor. You can decide the time to see your health care provider, and what type of treatment you want; as long as you remain in the limit that your insurer will pay
Disadvantages: in indemnity plans, most doctors require upfront payment, so you have to submit claim forms to the insurance company to receive a reimbursement. That requires paper work, and sometimes many phone calls. Fee-for-service plans offer limit benefits; they do not cover annual physical exam and educational programs.

HMOs (Health Maintenance Organizations) - Health maintenance organizations (HMOs) are managed care plans that offer health care coverage to their members through hospitals, doctors, and other health care providers that are in their network. That is, having their service, you are limited to members of their network.

Advantages: unlike Fee-for-service plans, you do not have to pay up front; although some of them require a copayment. You do not need to submit forms after forms to receive reimbursement. In addition, HMOs usually charge a lower cost.

Disadvantages: you can use only health care providers who are associated with the organization. Most HMOs (Health Maintenance Organizations) tend to refuse to approve certain treatments. Although some HMOs accept their members to see physician or specialists who are not in their network, they often charge you additional costs.

(PPOs) participating provider organization, also known as Preferred Provider Organizations - is a form of managed care organization of physicians , hospitals, clinics and other health care providers that sign a contract with an insurer to provide health services to its member at reduced rates . Usually, PPOs cost more than traditional HMOs, but offer more options to their members.

Advantages: Preferred Provider Organizations provide more flexibility to their members; they have a bigger network of doctors and hospitals. You can take service from health care providers that are not part of their networks (certain charges often apply). You pay Lower copayments for care from primary care physicians. In addition, you do not need a referral to see a specialist.
Disadvantages: PPOs cost more than traditional HMOs. You will more likely to make co-payments (usually from $10 to $30) when you visit a health specialist.

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