How To Develop Your Best Personal Health Insurance Plan

Summary: The State of the Personal Health Plan Marketplace

The marketplace for personal health plans is changing. As a result, healthcare consumers must consider changing their approach to this market.

The consumer challenge is to get acceptable coverage at a satisfactory cost. In the balance between time and money, you must decide which is more valuable to you. If you want to save money, you must get involved by spending more time to manage your healthcare affairs.

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The traditional plan design of managed care with low-deductibles, low co-pays, and low premiums has proven to be an unsound model. First dollar benefits have stimulated higher claims than anticipated. Quality service through managed care has proven elusive because of internal conflicts. Covering health expenses on a cost-effective basis has been negated by high annual medical cost inflation.

For insurers, all of these factors meant that costs exceeded revenues. No business can long survive with a negative bottom line. Changes were necessary. You can still get a traditional plan, but at much higher premium cost and with more restrictions.

How can you find your best healthcare solution in such a turbulent marketplace? These guidelines will lead you to the answer. They are generalities. They apply for most consumers. Details may vary for different insurers and in different states.

Are You Or You and Your Family Eligible For Personal Health Insurance?

First, let's touch on who is eligible for an individual or family comprehensive major medical health plan. Adults are usually eligible until they qualify for Medicare at age 65. Dependent children are usually eligible under a parent’s plan through age 26 in accordance with the 2010 federal healthcare reform bill.

Newborns may be covered at birth or upon a two-week Well Baby Exam. Expectant parents will usually not be accepted for a new plan but can be covered after the birth and two-week Well Baby Exam.

Who is not eligible? Incarcerated individuals, non-US citizens, unless they have a visa and green card and can speak and write English or have an interpreter, and those age 65 or over. Some insurers exclude applicants who have hazardous occupations or activities.

Disabled individuals are often not eligible for comprehensive major medical coverage but may be approved for Limited Benefit coverage. Limitations vary, so it is best to apply and seek a determination.

Beyond eligibility, there are two other major considerations that can affect your health insurance plan. The first are the plan terms and conditions. These are plan design cost factors over which you, as the insured, have some options and thus some control. For an explanation of these, go to our page on Health Plan Cost Factors.

The other considerations are the underwriting standards by which most insurance underwriters assess risk, evaluate insurability and assign rates. For an explanation of the underwriting process, go to our page on Health Plan Underwriting Standards.

* * * * * * * * * Insurance Quick Quote * * * * * * * * *

If you don’t need or don’t want to review the guidelines and prefer to seek a quote now, go to and complete the applicable quote request form to indicate your preferences, then click on the submit button to email the completed copies to us for a “Quick Quote” on availability and pricing:

• For an individual plan, go to Individual Health Plan Online Quote;

• For a family plan, go to Family Health Plan Online Quote.

• For a group plan, go to our Group Health Plan Online Quote.

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Additional Personal Plan Design Options

Self-Employed, individual and family health insurance plan designs which you can consider are as follows:

• Personal Health Insurance Plans:

For plan design explanation of individual and family insurance plans, go to Personal Health Insurance Considerations;

For Health Savings Account explanation, go to Health Savings Accounts;

• Short-Term Health Insurance Plans:

For a short-term plan design explanation, go to Short Term Health Insurance;

• Limited Benefit Medical:

For limited benefit and impaired risk plan design explanations, go to Limited Benefit Health Insurance;

• State Health Insurance Risk Pools:

For explanation and plan proposal, go to our state health insurance page and click on your state of residence. Then, on your state page, click on the state risk pool contact.

• State Children’s Health Insurance Program (SCHIP):

For plan explanation, go to State Childrens Health Insurance Plan;

For SCHIP plan proposal, go to our state health insurance page and click on your state of residence. Then, on your state page, click on the SCHIP contact.

• Medicaid Health Insurance Program:

For plan explanation, go to our state health insurance page and click on your state of residence. Then, on your state page, click on the Medicaid link.

• Medicare Health Insurance Program:

For plan explanation, go to our Medicare Plans Page;

For a Medicare plan proposal, send us a note on our Contact Us Page.

How can people support their
personal health insurance plan?

The most affordable health insurance is based on insureds assuming more responsibility for their fitness, health and affordable medical expenses. What proactive steps have you taken to better manage your family healthcare to stay within budget and not sacrifice quality? Will you help others by sharing your experience?

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