Fair deal on health insurance?

January 2009 | Modern Hygienist
Career: Exclusive Salary survey

Fair deal on health insurance?

Selecting your own healthcare insurance is often more difficult than receiving employer-provided insurance, yet it is well worth the added effort.

by Eileen White

When it comes to selecting their healthcare insurance, the majority of professional hygienists are on their own. According to the 2008 MH Hygienist Salary Survey, only 36% of respondents noted they received healthcare benefits from their employer. Many survey respondents listed healthcare insurance as a chief concern along with overall compensation.

This article lists some suggestions and precautions on finding the proper health insurance on one’s own.

Many hygienists work for themselves, as independent contractors, and must obtain individual health insurance policies. Generally, these typically are more difficult to obtain, and are more expensive than employer-provided group insurance policies. There are features to look for in an individual healthcare insurance policy.

 What to look for in health insurance

For those who do not have employer-based healthcare, an individual health policy can provide needed coverage. Here are some options to look for.

Non-cancelable guaranteed renewal

The insurance company cannot cancel your policy, as long as you continue to pay your premiums and commit no fraudulent acts such as claiming expenses that did not occur. This prevents the insurance company from canceling the policy should you become ill-this can and sometimes does happen in cases where the policy is allowed to be cancelled.

Grace period

After you purchase a health policy, you have 10 days to examine all the terms and conditions to decide whether you really want the policy. If you change your mind within this 10-day period, you may cancel the policy and receive a full refund of your premium.

Understandable terms and conditions

Without an employer health plan, you have an increased number of options to choose from. Be sure you understand the terms and conditions of your policy. Before you sign anything, know what your policy covers and does not cover, and the date on which your coverage starts.

Consider your lifestyle

Choose the right policy to meet your needs. A person in overall good health who does not visit a doctor regularly has needs that vary greatly from someone who often is ill and visits a doctor frequently. If you have children, consider coverage that benefits families who make frequent doctor’s visits.

Choose carefully

Just because your policy is an independent policy compared to a group policy, your coverage will probably be less comprehensive and more expensive. Although you may reduce the cost of your premiums by selecting a higher deductible, such a choice will have consequences if you need to make a future claim.

The theory behind choosing the highest deductible affordable is to lower your monthly premium cost. If a claim becomes necessary, those dollars saved then will be applied toward the higher deductible. However, if no need arises to make a claim, you’ve saved yourself money.

Where to begin

A good place to start is by looking for your own health insurance agent or broker…which often takes more effort than looking for a life insurance or a property insurance agent. This is because many people obtain health insurance from their employer, making individual agents scarcer. A good way is to check with your state’s insurance department for a list of independent insurance agents, check the Internet for brokers, or ask friends for references.

Note that there is a difference between an agent and a broker. An agent works for an insurance company, and may be allied with single or multiple companies. An independent agent is an independent contractor with the company or companies, and has the authority to legally obligate the insurance company to provide coverage according to terms and conditions as bound.

Conversely, a broker works for the client. A broker is not an insurance company employee, and has permission to seek insurance quotations for a client. As a representative for the insured, the broker approaches several insurance companies to provide adequate coverage. Unlike an agent, a broker does not have the authority to legally obligate an insurance company to provide coverage according to terms and conditions as bound. They present the client’s information to the insurance company, and if the company agrees, the insurance company will bind the coverage.

Esther Carrera, a health insurance broker with Carrera & Associates in Elk Grove Village, IL, says the first step anyone should take when looking for health insurance on their own is to determine coverage need.

“Determine whether you have a short-term need or a long-term insurance need,” she said. Although every case is different, according to Carrera, there are basic items to look for:

 “A deductible that is affordable, out-of pocket costs one can live with-including co-insurance expenses, and a provider network that is broad enough to suit even unknown future needs,” she said.

It can take awhile to get the right policy, and the process may involve evaluating several policies. Carrera recommends one should stop their looking when a particular policy answers their required needs.

Advantages of a broker

For all this, Carrera recommended enlisting the help of a health insurance broker, because finding insurance on one’s own can be quite time consuming, particularly while holding down a fulltime job.

In general, the broker interviews the client to determine client needs, any pre-existing conditions or medications the client is taking, hospitalizations, and deductible preference. The broker then seeks out the insurance plans best suited to the client (often while the client is busy at their own job).

Solo difficulties

Looking for the right healthcare policy on one’s own, without professional help, can average as long as six months, according to Carrera. Other disadvantages of looking independently, she added, can be a lack of knowledge-including failure to know what to look for, or understanding the terms used. Because of this, she said, the individual may end up very surprised at their results when they go it alone.

For example, where one lives makes a difference in health coverage. Some states have passed laws to guarantee coverage to all their residents-guaranteed-issue laws. Other states offer a “community-rating” system, which requires insurers to charge everyone the same standard rate, regardless of their health. Sometimes these requirements limit the ability of health insurance companies to raise premiums. But often, these well-intentioned laws have backfired, forcing some healthy people to pay much more for their premiums. Be sure to check your state laws.

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Yet another point: In general, health insurance costs more for females. Recent reports in the New York Times have outlined the difficulties of obtaining affordable health insurance for women in particular.  This does not surprise Carrera, who said that statistically, women are regarded as creating more claims, and they also have special health needs, such as maternity coverage.

“Ask your women friends how often they see a doctor, and then ask the same question of your male friends,” she said, adding that maternity coverage often is not offered in health insurance plans that are contracted independently, because of the complications that can develop from pregnancy and the costs that can result. Ditto for any pre-existing conditions coverage, for this predictably can raise costs for insurance companies. In turn, this gives carriers the ability to deny coverage.

In fact, if one’s health is generally poor, searching for insurance alone becomes much more difficult. Yet a broker may be able to help due to their knowledge of the market, according to Carrera.

“Brokers have an idea about which carriers to look at, depending upon the client’s health conditions,” she said.

Other alternatives

Not everyone wants to obtain health insurance through another individual. Some clients have the time and the desire to research policies on their own. There are state programs that offer comprehensive health insurance for those unable to qualify for policies offered by health insurance companies. In such cases, it is wise to check the state where you live, as the qualifications vary among states.

Another option is to compare different plans online. One helpful Web site is eHealthInsurance.com. This Web site asks for the gender of the applicant, spouse, and their children; dates of birth; whether the applicant has used tobacco in the last 12 months; whether the applicant is a full-time college student; beginning date of coverage; and applicant’s zip code. The applicant is then asked to press a “get quotes” button.

A similar site, digitalinsurance.com, lists prices for a different group of health insurance companies.

Yet another option is to join a professional association that offers group coverage, such as American Dental Hygienists’ Association.

But no matter which way you look for your insurance, Carrera recommends seeking professional advice.

“Look at it this way: I may think I’m doing an excellent job of cleaning my teeth, but of course, I seek out an expert at least twice a year to do the job for me. The same holds true for enlisting the help of an insurance broker for seeking health insurance. The cost is no more than if the consumer had contracted independently, and with a broker, the individual has someone available to help intercede with the insurance company, should the need arise.

 “I think it’s very difficult for someone not in the business to seek out a policy on their own. Think about it…if you’re buying a house, you’d use a real estate broker to help in the search, as well as have a lawyer at the closing. Looking for health insurance is no different. Go to an expert in the field,” Carrera said.  

Eileen White is an associate editor for Modern Hygienist.
To download the Salary Survey 2008 , click here.