Health insurance for individuals: a world of pain
02 01 08 - 15:50
Private health insurance is virtually out of the question for most uninsured Americans, according to a yearlong Consumer Reports investigation.
Research cited in CR’s report found that 89 percent of people who looked into buying individual insurance did not do so because it was too costly, they were turned down for health reasons or it provided inadequate benefits. And those who do manage to acquire insurance on their own are plagued with high costs and poor coverage.
People in need of private insurance face a daunting dilemma — buying limited health insurance at a high cost or forgoing insurance altogether. Who could fall into this category? Any adult who hopes to retire early, loses a job, is self-employed or has an adult child leaving a group plan.
The CR investigation found that consumers who bought individual health insurance had higher costs and more limited coverage than those who had insurance through employers. In addition, people who consider themselves in fine health can be declined insurance because of previous treatment, even for hay fever and acid reflux.
Consumer Reports found that state regulation of individual insurance plans varies widely. Someone who could buy insurance easily in one state could be shut out in another. And in a CR survey, 76 percent of people without insurance said they couldn’t afford an individual plan. Only about 7 percent of adults have individual insurance.
For consumers who plan on buying individual insurance, CR has come up with the following six tips.
• Know the state laws. Whether an individual can get health insurance, and how much it will cost, depends largely on a state’s laws and regulations.
• Be careful leaving a plan. Even in states that allow medical underwriting, the federal Health Insurance Portability and Accountability Act (HIPAA) provides some protection for anyone switching from job-based group coverage to the individual market — even with a medical condition that would make it impossible to pass medical underwriting. Exercising HIPAA rights requires exhausting all job-based coverage available, including COBRA, which allows the continuation of the employer’s plan for 18 months by paying the full cost plus 2 percent, then applying for individual coverage within 63 days after the old coverage ends. States have to make sure that at least one policy is available.
• Research the market. Start gathering information at ehealthinsurance.com, a reputable Web site that links to hundreds of individual plans nationwide. Consumers should check their state insurance department’s Web site, which might list companies licensed to sell health insurance.
• Get adequate benefits. Consumers should make sure that any policy they buy covers everything that is “medically necessary” for any health problem, including emotional disorders. That includes doctor visits, outpatient and inpatient treatments, all hospital expenses, drugs, preventive care, rehabilitation care, prenatal care and screening tests.
• Look beyond the premium. An insurance plan’s real costs include the monthly premium, the annual deductible and co-pays for office visits and prescription drugs. Be sure to understand which co-pays and co-insurance payments apply to the deductible and out-of-pocket limit.
• Keep looking. Thirty-four states maintain high-risk pools for people who cannot pass medical underwriting — information consumers can’t count on hearing about from brokers or private insurers.