The number of people buying their own health insurance is expected to reach 20 million in 2010, according to an analysis by McKinsey & Co. With rampant unemployment, it's tempting to just give up and buy a high-deductible plan with the lowest premium available. For better or worse, there's a lot more to think about when comparing Florida health insurance plans than the monthly price tag.
Be sure you are looking at an actual Florida health insurance policy and not a discount plan. Also, be careful to deal with major insurers that have been rated by independent rating organizations, like A.M. Best, for financial stability. While a rating of "A-" or higher doesn't guarantee all of your claims will be paid, it does offer assurance that the company has the financial ability to pay its customers' claims.
Here's What To Ask About Health Insurance In Florida
One the most important questions to ask is the amount that your out-of-pocket expenses will be limited to, which is known as the maximum out of pocket. Here's an example of why that's so important.
When Tina Smith bought a policy, she was impressed by low premiums and a $2-million lifetime coverage benefit. She did not realize that an annual limit of just $5,000 was lurking beneath that lifetime limit. This plan limited outpatient treatment to $5,000 a year.
When she developed lymphoma, Tina needed $91,000 for imaging scans and other outpatient services. "I'm not health-care savvy, and it didn't occur to me I had to go over this with a fine-tooth comb," she lamented.
Individual Health Insurance In Florida Has No Lifetime Limits
That $2 million lifetime limit was fairly standard, but health care reform has put an end to these caps on coverage. Insurance companies can no longer put a limit on the amount of coverage you can receive throughout your lifetime. You'll still need to guard against other types of limits, like the annual limit that resulted in such huge medical debt for Tina.
Also, be sure you understand how a plan's deductible works. You should only have one annual deductible, rather than one deductible per incident that could subject you to much higher out-of-pocket expenses.
Florida Health Insurance Limits Coverage For Pre-existing Conditions
When you're buying your own coverage in what's known as the individual market, it's very difficult to get coverage when your health is bad. Children with pre-existing conditions gained guaranteed coverage in 2010 with the passage of health care reform. Adults won't have that kind of protection until 2014.
It may surprise you to learn that pregnancy is termed "a pre-existing condition" in the individual market. Maternity coverage on individual Florida health insurance varies by the insurer and by the plan, but individual plans do not provide maternity benefits in the same way that group plans do. Most individual plans do not offer maternity coverage unless you buy an additional rider.
Shockingly, all insurers in the individual market refuse to provide maternity coverage once you are pregnant. That means you must buy this before pregnancy begins.
Worse still, insurers typically will decline your husband and children as well until after your baby is born.
Health Insurance For Florida Limits Maternity Coverage
When you are pregnant, all individual Florida health insurance plans can refuse you coverage until after your baby is born. If you get a plan with maternity benefits before you're pregnant, it will typically include a waiting period before you're eligible for maternity benefits.
For example, no maternity benefits will be paid during the first 12 months that your policy is in force, but you may have coverage even when you become pregnant during the waiting period.
Conception must have happened after you've had maternity coverage for a specific amount of time, such as 270 days. Any pregnancy that occurs before that 270-day limit would not typically be covered, at least not fully covered.
Maternity benefits may be incremental. For instance, you may have a small benefit if you become pregnant during the 12-month waiting period, a larger benefit should you become pregnant in the second year of coverage, and a much larger benefit when you become pregnant during the third year.
Carefully review any limits on your coverage, especially if you expect delivery complications, and remember to subtract your deductible. Maternity coverage is generally a separate benefit of an additional rider with a separate co-insurance charge and a deductible.
