What is individual health insurance?
Individual health insurance is coverage you purchase on your own,
directly from an insurance company or insurance agent (versus
group insurance, which you typically receive through your employer).
If you’re an early retiree, self-employed or on COBRA, you can
purchase major medical health insurance to help protect yourself and
your family against health care costs and get access to care. You pay
the entire premium each month; your employer makes no
With individual health insurance, you are not guaranteed coverage,
which is unlike an employer’s plan. Based on your current and past
health, it’s possible to be declined, or offered coverage at a higher
premium. On your application, you’ll be asked to submit medical
information. Your application will then pass through the insurer’s
“medical underwriting” process, which evaluates the costs of insuring
you and determining if you’re eligible for coverage.
Then you’ll either be accepted, denied or accepted with a “preexisting condition” waiting period before a current or past health
condition can be covered. You may also receive coverage at a higher-than-quoted rate due to pre-existing medical conditions.
To the extent permitted by law, these plans are medically underwritten and you may be declined coverage in accordance with
your health condition. If declined coverage, you may be federally eligible under the Health Insurance Portability and
Accountability Act (HIPAA) for a special guaranteed issue plan under your state’s laws and regulations.
Can I keep my doctors?
Quality individual health insurance lets you visit any doctor or hospital you choose, without a referral. Note, however, that you’
ll pay less out of your own pocket if you see doctors and hospitals in the insurer’s participating network. It’s helpful to choose
an insurer with a large, nationwide network of doctors and hospitals. This ensures when you travel, you’ll have access to
participating doctors and hospitals.
Are my prescriptions covered?
Quality individual health insurance will usually cover your prescriptions, after a deductible (the amount you pay before your
insurance begins paying benefits). Many insurance companies offer a choice of major medical plans, some with prescription
coverage and some without. Based on prescriptions you take now or have taken in the past, you may be offered coverage at
a higher-than-quoted rate, or possibly be denied coverage. Be sure to check how an insurer covers preferred, non-preferred
and generic prescription drugs, because plan details may differ.