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Individual Health Insurance

What it protects against

The financial consequences of obtaining health care.

How it works

Individuals pay premiums, and the insurance company pays for certain health-care costs covered in the policy. Most non-elderly Americans with private health insurance receive it through their employers, nearly all of whom pay at least half the premiums. Individuals must pay all premiums for individual health insurance. In most states, premiums vary by age, and most states allow insurers to medically underwrite applicants. Some states sponsor high-risk pools for people who cannot get coverage on the open market, though premiums can be high. In states where age-based premiums and medical underwriting are not allowed, average premiums tend to be higher. Premiums vary greatly by state.

Who needs it

Anyone without health insurance should consider buying it. Health-care costs can have catastrophic results on an individual's financial portfolio. Most health plans offer at least $1 million in lifetime maxium benefits. Some even offer $5 million or more.

Who may not need it

People with group health insurance through their employer or an association. Also, federal Medicare coverage begins at age 65. The poor may qualify for coverage under the federal Medicaid program or through state Children's Health Insurance programs.

When to buy it

When you don't have health insurance. A serious disease or accident can easily cost more than $100,000. Health care for the uninsured tends to be more expensive than for the insured, because insurers negotiate prices with providers in their networks.

How you pay for it

Periodic payments.

Terms to Know

  • Case Management  (View Definition )
  • Health Maintenance Organization (HMO)  (View Definition )
  • Health Savings Account  (View Definition )
  • Out-of-Pocket Limit  (View Definition )
  • Point-of-Service Plan  (View Definition )
  • Preferred Provider Organization  (View Definition )