Choosing The Right Coverage
Group Advantages:
- Your employer pays part of the cost and/or you share costs among members.
- You are assured of being accepted in the plan; i.e. you are guaranteed issue.
- Enrollment is easy.
- Your annual payment rate is guaranteed.
- You may get special coverages because of your employer or group.
- You qualify for COBRA benefits if you lose your job.
Group Disadvantages:
- You lose some or all of the cost-benefits from an employer’s group insurance if you lose your job.
- You may be limited in your choices for health care providers and facilities.
- You do not decide the details of the program.
Individual Advantages:
- Your plan cannot be cancelled once you are enrolled.
- You can choose the details of your plan.
- You can adjust copayments, coinsurance, and deductibles to save money.
Individual Disadvantages:
- You pay the full cost of insurance, and your portion for all medical services.
- Application requires examinations and personal history.
- You are not assured of being accepted; i.e. you are not guaranteed issue.
- You may face rate changes without warning.
- You cannot get COBRA or HIPAA benefits.
How Can You Pick the Type of Plan?
Picking the type of plan is a balancing act of cost versus freedom of choice. (If you are part of a group, you may not be able to select the type of plan.)
Advantage: A managed care plan generally reduces costs and standardizes treatments,
Disadvantage: but has limits and choices beyond your control.
Advantage: An indemnity plan lets you get your medical care wherever you choose
Disadvantage: but is more costly.
- Know your basic medical needs and preferences.
- Make some decisions about what’s important to you: Do you want to keep your current doctor? Is there a preferred hospital nearby? Are you willing to wait for reimbursements? Will you likely need to see a specialist?
- Study the advantages and disadvantages of the different managed care and indemnity plans.
- Get some quotes to determine how much what you want will cost.
Consider Your Personal Health Profile
If you have special health needs, think about them before you enroll in a plan. Look over what kinds of options would best help you meet these needs. Get quotes that include these options.
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