Prior to World War II, nearly all health insurance policies in the United States were issued to individuals. In an individual health insurance policy, a person agrees to pay a monthly premium to an insurance company, which in turn agrees to pay for or reimburse a certain amount of the cost of health care for that person and whichever relatives and/or household members are covered under the policy.
In an individual health insurance plan, the policyholder pays the entire premium, usually on a monthly basis. Often, there is also a deductible, an amount which must be paid out of pocket before coverage kicks in. Individual health insurance premiums and the conditions covered under the policy are based on the health history or histories of those covered under the policy. Where some states require certain types of coverage, individual health insurance options will cover these conditions for all policyholders, but charge higher premiums to make up for this cost.
Some of the following factors may affect the coverage or premiums of your individual health insurance policy:
Most insurance companies assume that women of childbearing age will require coverage for either birth control methods or pregnancy and birth care, so women will often pay more for individual health insurance policies than men of similar age and health.
Lifestyle and Habits:
Excessive drinking, smoking, overeating, and participation in extreme sports may raise premiums or limit what is covered under your individual health insurance plan. Very few companies reduce premiums or increase coverage for those who can show healthy habits such as proper diet and exercise.
Personal Medical History:
If you have undergone multiple surgical procedures, broken several bones, been hospitalized for mental health reasons, been treated for or convicted of substance abuse, or show any risk factors for chronic or recurrent conditions such as asthma or Crohn’s disease, insurance companies generally assume that these problems will recur. Individual health insurance plans for those with such conditions in their medical history will generally pay higher premiums, have all potentially related conditions excluded from coverage, or be denied coverage completely, even if surgeries were preventive or if symptoms have not manifested in a long time.
Family Medical History:
Many companies will ask about your family’s health history when determining the premiums and coverage of your individual health insurance policy. If members of your family were diagnosed with and/or died from diabetes, cancer, heart disease, stroke, dementia, epilepsy, mental illness, or other diseases which might have genetic factors, you will probably pay more and/or find that these conditions are not covered.