Guide to Purchasing Health Insurance
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Health insurance is available through either group insurance or individual (non-group) insurance and can be purchased from a variety of companies including traditional fee-for-service insurers and health maintenance organizations (HMOs).
Group health insurance is available through employers, associations, or purchasing pools. Individual (non-group) insurance is purchased by an individual and can cover families. Insurance reforms have made it easier for individuals to get and keep insurance coverage. For example:
- Self-employed people may be able to deduct up to 100 percent of their self-employed health insurance premiums on their federal income tax returns.
- Health plan companies may not refuse to renew an individual (non-group) policy as long as you pay your premiums; this is known as guaranteed renewal.
- Limitations for preexisting conditions may be in place for no more than 12 months except that groups may exclude coverage for late entrants for up to 18 months. A late entrant is someone who declined coverage at an initial, open or special enrollment period and who then asked to be covered. Consumers may change health plan companies and receive credit for any preexisting condition limitation they have already met as long as they maintain continuous coverage. A new insurance company may not impose another limitation if they have already satisfied the 12 month preexisting condition limitation. This helps people who wish to switch jobs and keep adequate coverage.
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- Women cannot be charged more for health coverage than men of the same age.
- Unmarried dependents under age 25 can be covered by their parent’s policy. This Minnesota law does not apply to most self insured plans. Dependent children of any age who are disabled can be covered by the their parent’s policy.
- Premiums for individual, conversion, most Medicare-related (not Medicare Advantage plans) and small group health plans must be approved by the Minnesota Department of Health or Minnesota Department of Commerce.
Individual (non-group) insurance may be purchased from a variety of companies. The difference between traditional fee-for-service plans and HMOs is not as clear as it once was. Most fee-for-service plans have adopted managed care practices to control costs (such as utilization review, which is a determination of appropriateness and effectiveness of medical treatment received or to be received by a patient) and to provide preventive health services. HMOs are offering consumers more freedom to choose doctors, similar to fee-for-service plans. By studying your health insurance options carefully, you will be able to pick the one that provides you with the coverage you need, no matter what it is called.
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