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What Should I Know Before Buying Individual Health Insurance?

The destined day has finally arrived and it’s time for you to make a decision. Trying to decide which insurance you want or if you even want insurance is a daunting process. You’re left with opinions from others and comments you’ve read online from those uninsured. The most common retort toward owning health insurance is it’s cheaper to not have it. Sure, premiums are slowly rising every year and not everyone has hundreds of dollars laying around. However, the costs of going to the doctor without insurance can financially hurt.

Going to the doctor without insurance can cost up to 200 dollars or, at minimum, 150 dollars. While most doctors will cost this much, emergency rooms can cost more and leave you with a bad taste in your mouth. Most emergency rooms are dealing with severe wounds and traumas—emergencies—which is another reason to avoid going to the emergency room without insurance. Considering not everyone goes to the doctor frequently, this could be reason to convince you not to get insurance or see the doctor.

Unfortunately, accidents happen and sometimes they can be expensive. The lack of health insurance leaves people in piles of medical debt because of being uninsured. Being in one serious accident can cause you to drop thousands of dollars, even tens of thousands. Were you to injure your leg and not get surgery or a cast, you’ll still have to pay up to 2,500 dollars. Combining the cost of the x-ray and the surgery will raise the price to five-digits, even six-digits. Acquiring health insurance isn’t as expensive once you look around and you’ll protect yourself in the long-run from financial and physical turmoil.

How Much Will Health Insurance Cost?

Picking the right health insurance for you is an anxiety inducing situation. You have to look at the benefits it gives you, compare them to other plans and if you can financially afford it. Health insurance programs come in a variety of plans and categories, but understanding what each one does can make your decision making process easier.

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The Four Categories of Health Insurance

Within each health insurance plan are four “metal” categories to choose from:

  • Bronze
  • Silver
  • Gold
  • Platinum

These categories have nothing to do with the quality of care you receive, this is reserved for the plans available. However, these help you decide what you are paying and what you are splitting with the rest of the insurance clientele. Were you to choose the bronze individual health insurance program you’d have to pay the doctor more than the other categories, but you’ll also pay the least amount on your premiums. Seeing a doctor might not be your priority and saving money is, which is fine but never stop at the first option you see.

Silver is a little more expensive, but it’s at a modest price. Nothing to extreme and nothing to loose; the perfect balance. The best part is if you qualify for “extra savings” you’ll be able to save more money, but extra savings is only possible through the silver program. Were you to go a step higher—like the gold health insurance program—you wouldn’t be able to receive extra savings, even if you did qualify.

Gold is the more expensive option for monthly premiums. However, you’ll pay less when you actually go to the doctor. Typically, the insurance will pay for 80 percent of the costs while you pay 20 percent. Bronze you’d have to pay 40 percent, and silver would require you to pay 30 percent of the costs at the doctor. Those who need regular or more than average medical care would choose this program.

As you’ve noticed, the more extravagant the metal the less you have to pay the doctor, but the more you’ll have to pay the insurance company. Platinum health insurance coverage is no different. Acquiring the platinum category for health insurance would mean you’d have to only pay 10 percent of the doctor bill, while the insurance pays for the other 90 percent. This plan is for people who see the doctor commonly or work in a more dangerous field. Nonetheless, within these metal categories are different plans either increasing or decreasing the amount you pay.

What Type of Plans are There?

Metal categories deal with how much you pay the doctor and the insurance, but the type of plan you choose decides the care you receive. There are four marketplace plans to choose from:

  • Exclusive Provider Organization (EPO)
  • Health Maintenance Organization (HMO)
  • Point of Service (POS)
  • Preferred Provider Organization (PPO)

These plans decide who you see and how you see them. Picking an EPO plan would require you to see only the doctors, specialists and hospitals in its plan’s network. Fortunately, you can still see those out-of-network, if it were an emergency. An HMO is similar in that it will let you see those not on their contract or network if it was an emergency, but your chances are slimmer. It usually limits the coverage to people they work with and usually won’t accept those they don’t know. Unfortunately, most HMOs are restricted to certain regions, which you have to live in.

HMOs are unique in that it is the only one requiring you to live in its region; a POS won’t. A POS is nearly identical to an EPO, except you’ll need a referral to see a specialist, normally acquired by your primary doctor. A PPO, on the other hand, doesn’t need a referral to see specialists. Seeing its hospitals will also keep you from spending too much money as you pay less seeing those in its network.

Will Health Insurance Cover Death?

While, you’ll save money choosing a PPO program, individual health insurance programs don’t cover deaths. You don’t receive a compensation nor obtain money for the funeral costs. You’re left to deal with this yourself. Health insurance is important for keeping you healthy and financially stable, it doesn’t leave you with options for death coverage. However, there is insurance in the case someone passes away. Life insurance is as important as health insurance as it doesn’t leave you in debt once someone passes away.

You’ll receive a compensation for their death, enough to help those pesky funeral costs. Not only that, but if the person covered is diagnosed with a terminal illness it’ll help you pay those costs, allowing you to recover without worry. Accidents happen frequently and they’re not intended, which makes them random. Getting injured is traumatic enough don’t further it by going into financial ruin.


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