Regardless of the economy, finding health insurance is a daunting task for self-employed individuals. Federal law mandates businesses with more than 15 full-time employees to provide health insurance.
There are dozens of health insurance companies advertising on television and the internet, all promising affordable health care plans. Affordable doesn’t always mean full coverage, though. By following the tips given here, self-employed individuals can choose plans for themselves and their families with proper coverage.
Begin With History
In a notebook, write down your medical history and that of your family. List all medical conditions, medications treatments still needed, if any. This may seem like a redundant task, however it could save thousands in annual premiums/health costs.
Create a Questionnaire
At the top of each page, list the company’s name, address, phone number and email, if given. List the agent’s name and phone number, the date and the time of your interview.
List questions on a sheet of notebook paper. Fill in the answers as the agent explains their company’s policies and coverage. Be prepared to spend time on the phone, this isn’t a decision to jump into lightly.
Leave yourself notes to enter about the agent’s responses. Were they straightforward? Was the agent edgy or nervous about being asked so many questions? Did they have a problem giving straight answers, or did it seem as though they were trying to dodge the questions? For example, if the agent were asked about catastrophic coverage, did he or she respond with something like, “our company offers the most affordable coverage.”
If you think of additional questions, write them down and ask each company the new question. Record the answers.
Questions to Ask
• “I need to see a doctor for this medical condition during the year. Is that covered, and how?”
• “What out of pocket expenses will I and my family have under this plan?”
• “What medications/dental/eye exams are covered, and what is not?” Let the agent know what medications are currently prescribed, and if on the agent’s list a different medication can be prescribed. Do not ask for a change in prescription because of an insurance agent. They are not doctors. Speak to your doctor first.
• “Will full coverage take place under this plan, and under what conditions?”
• “What are the deductibles and copays under this plan?”
• “How is emergency treatment covered?”
• “Is catastrophic coverage included? How?”
• “Is there a discount for military/former military/senior/non-smoker or drinker/a healthy person who hardly ever needs more than preventative care?”
• “Are the premiums yearly/bi-annually/monthly/weekly?”
• “How much will this plan cost, in total?”
• “Are there any other costs you haven’t discussed?”
• “Is there a provider network (a network of doctors who have signed a contract to provide care at a discount to insurance customers), and is my current provider covered under your plan?”
• “Is out of network care covered, and what would my costs be?”
• “What is the prescription coverage under this plan?”
• “If my doctor prescribes name brand only, do I have to pay full price?”
• “Are only generic medications covered, or can I get a discount if I choose an available generic over a name brand medication?”
• “If I select a higher deductible, will that lower my premiums?”
• “Is this coverage a discount plan or a true insurance plan?”
• “How are claims filed?”
• “Do you pay the doctor/pharmacy/hospital, or do I receive a check and pay them myself?” This is often associated with lower cost style plans, because you do paperwork that higher cost plans do for you.
• “Does this renew every year or do I have to sign up again?”
• “Can I cancel this plan before the renewal date if I’m not happy?”
Compare the Plans
To make comparison easier, interview several companies. Both large companies and small can be compared equally with your questionnaire.
By making careful comparisons the best plan for you and your family can be chosen.
Tips to Help Keep Costs Down
• Add up all the prescription costs, deductibles, and copays you pay now. Work to keep this amount in savings so when you need the money it’s there.
• Never spend the money for your health insurance deductibles, medicine or premiums on anything else. Walk or take the bus rather than use this money to fix the car or go on vacation.
• Strive to maintain proper weight and health for yourself and your family. Remember the old adage, “An ounce of prevention is worth a pound of cure.”
• If you smoke or drink, stop. This reduces the need for medical care.
• Learn what symptoms need to be seen by a doctor and what can wait. Many people go to a doctor’s office unnecessarily, raising health care costs.
• Never fail to go to a doctor for necessary treatment because of premiums, copays or costs.
Insurance Plan or Discount Plan
This is an issue currently sweeping across America. Many companies offer “low-cost” plans, claiming that all doctors, hospitals and pharmacies are no problem for coverage. People sign up for these plans, go for medical treatment and are shocked to find out they owe the entire bill.
What they signed up for is a “discount plan,” similar to a discount program at a membership shopping club or store. Unfortunately, not all doctors/hospitals or pharmacies participate in any of these plans. The customer has a false sense of coverage, and depending on the contract signed, may be stuck paying for the plan for a year or more.
It’s worth taking the time to carefully shop for the right plan for yourself and your family. For those who are self-employed, the current income tax laws allow the self-employed person to deduct their premiums as a business cost. Keep careful records throughout the year and add up out of pocket expenses as well. If they meet a certain amount, the current tax law also allows some of this expense to be deducted as well.
Once you find the right plan, you can rest easy knowing you and your family is covered.
Source: The author of this article has extensive experience in the health insurance industry.