Starting in 2014, many people will be forced to getting health insurance.  This is because of the health reform and the news rules that came out two years ago.  It is currently in the Supreme Court and they are ruling whether or not the health reform laws are constitutional.  The ruling should come out in June of this year and it will have a huge implication on the health care industry.  Currently, there are over 4 million people with no health insurance in California.  Many of these individuals will be searching for health insurance in the next two years.  As the economy continues to struggle, many are forced to buy individual coverage as the group insurance market is still weak.  Another concern though is the affordability of health insurance.  The monthly cost is still very high and many are wondering if they would rather be without insurance.  If your healthy, many will not need it because they won’t use it, and if your unhealthy chances are you will not be approved.

The health reform makes it that no one will be denied health insurance in 2014.  The health insurance exchanges in each state will make an online marketplace where people can shop for affordable individual health insurance.  It still remains to be seen how many will actually use this channel to get health insurance.

Each health insurance plans has unique benefits and some vary by what they give you.  Obviously, the more you are willing to spend in monthly premium the better your benefits tend to be.  Most individual health insurance are offered through the PPO channel.  Additionally, these benefits are driven by three major factors: deductible, prescription benefits and out of pocket maximum.  The deductible is the amount of money the member is responsible for before the insurance carrier will start to help with expenses.  Once you reach your deductible, you will be paying your coinsurance rate until you reach your out of pocket maximum.  This is an important number.  Because generally, it is your ceiling, basically your worst case scenario for the calendar year.  The lower the out of pocket maximum, the higher your monthly premium will be.  So you have to make a trade off and ask yourself how much you are willing to pay and what the probability is of the worst case scenario.

Most health insurance plans have a out of pocket maximum around $3,000 to $7,000.  It is important to know your health history before making this decision.  If your generally a healthier person, then maybe choosing a health insurance plan with a higher deductible and out of pocket maximum makes the most sense for you.  And also, will save you the most amount of money.

Many health insurance plans have similar benefits, however, it is important to always pay attention to the benefit detail for each plan.  Some plans are stronger for medications, while others are stronger when you visit the emergency room.  A common question we always get is how much will it cost when I visit the general doctor.  Many health insurance plans cover office visits.  However, it is important to know that the benefits are not all the same.

For instance, some of the health insurance plans that have lower premiums will place limitations on visiting the doctor.  The plan might cover the first three visits, and then you pay 100% of the negotiated fee.  This may be an important thing for you to consider.  If you regularly visit the doctor, then plans that have those limitations will not work.  When you start to research and purchase plans with higher monthly premiums, then they usually give better benefits for visiting the doctor.  Some plans have unlimited visits for a fixed dollar amount.  Also be careful though that you know what the costs are for out of network visits as it can be a lot more costly.

Many consumers assume that each plan with each carrier works the same.  It is actually very untrue.  One plan that has a $5000 deductible could be very different then another plan with the same deductible.  Each carrier has different benefits within each plan that helps them differentiate from the competition.  For instance, Anthem Blue Cross usually has very competitive rates for individual health insurance plans.  However, many of their health insurance plans do not have strong medication coverage.  Some of their lower plans have huge brand deductibles that you first have to meet before you can start getting covered for medications.

Others carriers may have strong prescription coverage, but might have limitations on doctor visits.  That can get very pricey.  It is very important when researching health insurance plans that you look very closely at the benefit details of each plan.  To make matters more complicated, each carrier has their own underwriting standards.  So that means that one carrier might approve you while another may not.

Individual health insurance is unlike group health insurance where their is no individual underwriting.  When you apply for individual health insurance, you may get denied for a number of reasons.  For one, a health insurance carrier will typically look back three years and get your claims history to see how much has gone through the system.  If they see that you have a lot of complications, they may instantly deny you right on the spot.  People with recurring health issues have a tougher time getting approved for individual health insurance.  Also, carriers may request a new physical to be done to see whether or not your currently healthy.  If you do get denied, there are still some other options. 

Each carrier has different underwriting standards, so you can always try to apply for a similar plan with another carrier.  When they deny you, they will typically give a reason, so you can better guage if it makes sense to apply with another carrier.  Another option is to get insurance through your states high risk pool.  Each state usually has a program for higher risk applicants to get health insurance.

Most individual health insurance plans in the marketplace are PPO plans.  Their are some HMO and HSA options, but the most affordable options are PPO.  Under PPO health insurance plans, you can self-refer your medical services and do not have to wait for referrals which could take a long time.  The networks under PPO health insurance plans are usually really large so you have a wide variety of doctors and medical groups to choose from. 

Health insurance carriers such as Aetna and Anthem Blue Cross have very large networks in California, and their hospital networks are large as well.  If you really want a HMO or HSA health insurance plan, then you do still have some choices.  The plans might be a bit more expensive though because the benefits tend to be a little richer under HMO health insurance plans.