California Individual Health Insurance
Individual Health Insurance (Personal Health Insurance or Private Health Insurance)
- Taken out solely by the person insured, or subscriber, for himself/herself, or for the person and family.
- Totally paid for by the subscriber.
Individual health insurance is the type of coverage you need if
- you are not covered by an employer’s group plan.
- you do not belong to group or organization through which you can buy coverage (such as the university you graduated from, AARP, a professional group or union, etc.)
- you are not eligible for publically subsidized coverages such as MMRIP or Medicare.
You Pay for All Your Health Expenses
An individual with California individual health insurance pays the total cost of his or her own health care. The individual pays the premiums for the health coverage as well as all out-of-pocket medical expenses not covered by the plan.
Individual insurance costs are normally based on age, zip code, health and health history, and lifestyle choices.
In California, as in other states, individual health insurance plans tend to cost more than group plans and provide less coverage. Insurance companies have fewer regulations that determine rates and coverages for individuals, so you need to study and compare quotes from insurance companies to know what you are getting, and for what price.
How Can You Get Individual Health Insurance?
Most individual health insurance plans require a medical examination. Many use questionnaires on health history. An individual may be denied coverage or pay a higher premium for coverage if there is a pre-existing medical condition. California law does not allow an exclusionary rider but companies may impose an exclusion period, forcing the individual to wait a certain time for coverage.
Older individuals or people with a high-risk of illness may have difficulty getting a new policy, or they may be charged a higher premium.
California law requires that insurance companies renew existing individual health insurance plans. But once an individual has a plan, changing to another insurance plan may be difficult. So comparing and making the best choice in the first place is very important.
Who Selects the Details of an Individual Plan?
If you are applying for California individual health insurance, you will be negotiating with the insurance company to select the insurance plan you want and also the details of coverage. You may want coverages for maternity or for disability. You may want vision and/or dental coverage.
Take a look at the advantages and disadvantages of health insurance plans to find the type of plan that would best work for you, or for you and your family.
What If You Move from a Group to an Individual Plan?
An individual who loses group health insurance and must move to an individual plan has some government help.
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COBRA (Consolidated Omnibus Budget Reconciliation Act): COBRA applies to group-plan employees who worked for a United States company employing more than 20 workers. The employer must offer COBRA insurance to an employee who loses coverage due to qualifying events—such as by being laid off. COBRA for an individual or a family often lasts 18 months, and under certain conditions, up to 36 months. The premium is generally lower than for most individual insurance coverage but still relatively costly.
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Cal-COBRA: Group-plan employees who have lost coverage from companies with 19 or fewer employees or who have exhausted COBRA benefits may qualify for Cal-COBRA for an individual or a family, for up to 36 months, at a premium generally lower than regular insurance coverage.
What If You Have Trouble Getting Individual Insurance, or Paying for It?
The federal government and the state of California have programs in place to help some individuals with health insurance issues. Some of these programs include
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Major Risk Medical Insurance (MRMIP): Individuals who are in a high-risk group may apply for this California program, which allows members to pay a reduced premium because of additional funding from the state’s tobacco tax.
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Medicaid: Low income Americans with physical difficulties (elderly, blind, or disabled individuals, for example) may apply to this federal-state program.
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Medicare: For retired and some disabled Americans, the federal Medicare program covers some medical costs.
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Medi-Cal: In California, people with long-term disabilities may get help from the California state government Medi-Cal program.
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