So, as a currently unemployed member of US society, I am tasked with the daunting necessity of having to procure my own health insurance. I'll be spending a lot of time snowboarding this winter and when the waves are decent, I'll be surfing. So I definitely need to have some kind of insurance policy, although I'm a fairly low maintenance patient who tries to avoid doctors unless absolutely necessary.
I'm assuming that this task is confusing and seems overwhelming to most, and I certainly had no idea where to begin. Whenever I'm tasked with an issue that I can't solve on my own, I take it to the Internet.
After googling "private health insurance," I came up with www.ehealthinsurance.com. This is the first place I looked. They have you fill out a little questionnaire and then you give your email address. I figured I'd give it a few days before I got a response by email. Boy, was I wrong. After about an hour had lapsed, and I had clicked on a few more websites that provided me with no particularly good information, my phone began ringing with numbers I didn't know. I have a personal policy that I always let the voicemail get an unknown number (I hate surprises on the telephone) and I call back when the message is left. Well, none of these five different calls left a message, so when the first one repeated, I answered. I told the agent (Licensed Insurance Agent is the official title) I was busy at the moment and asked if he could he call me back at a better time. He did.
Upon returning my call, this agent begins what salesmen term the "hard sell". Before he even started the full pitch for the particular plan I wanted, I told him that I am not going to enroll on the phone at that moment because I had more research to do. He respectfully argued that I shouldn't have reservations, that he's the professional, etc. Anyway, I went ahead and listened to the plan information. It's for a PPO and the company is offering a special group enrollment rate to meet their quotas for group plans. All of the terms and conditions sounded great to me. I told the agent that I thought it sounded good.
Immediately, he said, "Now, let's get you enrolled." I repeated my initial statement that I was not interested in enrolling immediately. He them attempted some sort of guilt trip to tell me that he has worked hard at explaining how great this plan is, and it's not fair to him for me to go elsewhere. Is this guy kidding me? So I again (respectfully, I might add, because I was getting pretty miffed but I didn't get too upset with him) explained that this is my healthcare plan, and I am not going to hear one good policy and not comparison shop elsewhere.
So, here's where the interaction gets pretty annoying. Jim is finishing up cooking dinner, and I'm getting hungry while on the phone with this agent for 42 minutes total. He reminds me that I stated I could afford the plan plus the enrollment fee (what I'm assuming is his commission, but I don't know for sure). But I remind him that I have no income, and I don't wish to just throw my $99.95 enrollment fee out the window in case I find a better option for a healthcare plan. Finally, I was able to talk this guy down and agree that he should call me back on Wednesday at a set time after I have had a chance to do a bit more research. So that is where I am with my particular plan purchase.
Although I didn't particularly enjoy his sales tactics, I've heard that insurance agents are a particularly pushy lot, and at least the guy had a sense of humor. After doing some more research around the Internet, I plan on going with the plan this fellow offered me after asking him a couple more questions.
Please comment below if you have had any similar experiences or if you have any good advice to offer.
Here are some of the basics that I've learned through my research:
Important terms:
Deductible: the amount of medical expenses that the patient must pay out of pocket before the insurance company will begin to pay any of those expenses.
In-network: If the plan has a network, the doctors that have negotiated and signed a contract with the insurance company are considered "in-network".
Premium: The amount charged (usually on a monthly basis) for your insurance coverage. Essentially your service fee for being on the plan.
Types of plans: (**The details and particular amounts and percentages vary by provider, but these are the basic plans.**)
PPO (Preferred Provider Organization): This policy is a network of providers that the patient is free to see at-will. The insurance company agrees to pay a set percentage of the costs for doctors that are within the network, but if the patient wants to see an out-of-network doctor, there will usually be a higher cost to the patient, although the insurance company will cover some of the cost regardless.
HMO (Health Maintenance Organization): This is a grouping of clinics, physicians, and some specialists that the insurance company works with exclusively for your plan. Your primary care physician (who has to be part of the HMO) is the only doctor who can give you referrals to other doctors within that system. If you want to see a particular specialist, then you have to pay for it yourself if that specialist isn't in your HMO's system.
EPO (Exclusive Provider Organization): Similar to an HMO, in that there is an exclusive network of doctors that the patient can visit. There is no allowance for an out-of-network provider, so any specialist out of the network has to be paid for in full by the patient.
POS (Point of Service): Your primary care physician is your "point of service." This doctor has to refer you to specialists that are in the network. It's much like an HMO, but there is greater freedom to see out-of-network specialists. However, you have to pay a higher premium for partial payment to these out-of-network specialists.
Indemnity: No organization of doctors or clinics, so the bill must be paid in full by the patient. The patient can then submit the bill for reimbursement to the insurance company which will reimburse a percentage of the bill. This is the most out-of-pocket risk plan, as the patient is responsible for the payment, and not the insurance company.
HDHP (High Deductible Health Plan): This plan doesn't have a network of doctors, so you have the freedom to see which doctors you choose. As indicated in the name, the deductible for this plan is high, and once that deductible is met, the insurance will pay a percentage of the bill.
I also found this handy-dandy guide in my Google search, but it's very broad.
**Please note that I am not a Licensed Insurance Agent or even a professional within the insurance industry. I'm just trying to figure out the best ways to do these things, so I'm reporting on my progress.**
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