Choosing a health insurance company is as important as choosing a doctor, an important decision that could save your life (or at least your finances). People often don't investigate buying health insurance or understand what they already own until it's too late, when they're faced with a costly disease or accident. This is particularly relevant to the LGBT community, because often we're excluded from our partner's insurance, or our families may be unavailable for financial support.
Get Insurance Before You Get Sick
Those who choose not to buy insurance because they "never get sick" may be in for a shock if they suddenly are faced with an unexpected accident or illness. If you think you're invincible, go to any emergency room and quietly take a poll to see if anyone planned to be there. I have a hunch about the results of your survey. If you are from the "wait and see" school of thought, be aware that most insurance policies have a pre-existing clause that will force you to wait up to one year before the company will cover the costs from that accident or illness. You will still have insuran ce coverage, however, and all other costs not relating to that incident will be covered. So if you do "wait and see," make sure you have adequate cash on hand to cover a year of out-of-pocket medical costs.
Group Plan for One
The process of choosing a health plan is similar, whether you are looking for an individual or group insurance. It's important to note, individual plans are the least profitable for the insurance company, and therefore the most costly to the insured. Therefore, you should always aim to be a group, even if you are a group of one (if you are a consultant or sole practitioner). They always offer better coverage at a lower cost than an individual plan. Insurance premiums are a tax deduction for many businesses. Speak with your tax planner to determine how much of your premium may be used as a business expense.
Key Points to Consider
Basic plans known as health maintenance organizations (HMO's) include a prescribed network of doctors. Because these doctors have already agreed on fees for services to render, the cost savings to the insurance company can be passed on to policy holder. HMO's are terrific if you have a doctor who is in the network or if you are willing to switch to a doctor who is part of a plan. Be aware that most HMO's have gatekeepers, meaning that in order to see a specialist, you must first see your primary care physician for a referral. If you don't want this added step, then you should choose a non-gatekeeper plan. However, you will pay more for this. One more thing: with an HMO, you are committed to using a network in good times and in catastrophes.
For those who want more freedom, an out-of-network option will allow you to go to any doctor, on a regular basis or in the event of an emergency. For this freedom, you will pay a higher insurance premium. Increasing your out of network deductible, altering the coinsurance percentage, changing your prescription plan and other options can decrease the higher premium. If you are in the market for insurance, give yourself time to research your options and mull them over. As LGBT people, we often stay loyal to a particular doctor to avoid having to "bare all" every time we need a check-up. If you have not yet found a doctor, shop for one as you would for an accountant, lawyer or financial planner. Make sure you find a competent doctor before you need him or her.
If you already have a good doctor, your first step in choosing insurance should be to ask you doctor for all the networks he or she is part of. This will help you narrow down your search for an insurance plan. If you are a small employer, poll your employees to get an idea of which network would most accommodate them. For added flexibility, you may also add an out-of network-benefit to whatever plan you choose. This is important, since as of now there is a limited number of doctors who specialize in and/or are sensitive to our needs. Keep in mind, in the event of an emergency, you may be forced to go out-of-network, even if your intention was to always stay in network.
Once you understand the basics of insurance, and have narrowed down your options and chosen your price range, a financial planner or insurance broker who works in this market can help you decide which plan is best for you. There are few bargains left in health insurance, but there are good values and certainly ways to lower premiums by eliminating unnecessary plan options. Also, an experienced broker can steer you toward plans that have served his or her clients well and away from ones that have been problematic. Remember, it is better to cover your bases today to avoid a potential health (and financial) catastrophe tomorrow. You can't put a price on peace of mind.