Thirty-two states operate high-risk pool programs for people who have trouble buying individual health insurance because of their health. Eligibility for these programs varies, as do premiums and covered benefits. Contact the program in your state for more information.

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Discount plans are not insurance. They do not protect against financial ruin, nor do they assure access to expensive health care, such as hospital or emergency room care or surgery. Discount plans work more like savings coupons. The plans negotiate with various providers to provide services at a discounted rate to enrolled members; but members remain responsible for paying the entire balance of the charge, no matter how large it is.

Typical monthly payments for discount medical plans range from $30 to $70 (some as high as $150) per month per person. In addition, discount plans advertise they will accept all applicants, regardless of health status and existing medical conditions. The relatively low cost and “guaranteed issue” features of discount plans may be attractive to people with chronic conditions, such as diabetes, who often have trouble buying private health insurance at any price.

If you are thinking about buying a discount plan, keep in mind the following:

• Contact the providers you plan to use to verify if they participate in the discount plan. If they do participate, find out whether they are obligated to charge you the discounted rate.
• Ask the providers whether they would be willing to give you a discount even without the plan. Keep in mind that many providers give discounts as a courtesy to their patients without health insurance.
• If you are buying a discount plan online, make sure the site is secure and don’t forget to review the discount plan’s privacy policies. Also make sure that the discount plan’s phone numbers are working and you are able to talk to a live person. Keep the phone numbers and address in your files for future reference.
• Discount plans are not regulated by your state insurance department and may not be regulated by anybody. However, any misrepresentation or fraud by discount plans should be directed to your state’s Office of the Attorney General. To find out if there have been complaints against the plan you are considering, call your state’s Office of the Attorney General as well.
• Discount plans are not considered creditable coverage. Because a discount plan is not insurance it won’t count toward reducing a pre-existing exclusion period if you subsequently get covered under a job-based group health plan.
• Find out exactly how much you have to pay monthly including any additional fees such as administrative, membership, and annual fees. Make sure that the discounts you get exceed what you pay for a discount plan membership.
• Read all materials carefully. Make sure you read the fine print. If it seems too good to be true, it probably is.

There may be information available on your state’s Department of Insurance website on discount plans. As sales grow, states such as Kentucky, Colorado, Washington, Florida, and Georgia have issued consumer alerts to educate people about discount plans. For more detailed purchasing tips and other questions to ask when buying discount plans refer to these states’ Department of Insurance websites.

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State regulators have taken control of American Benefit Plans’ operations and are collecting assets in an effort to pay at least some of the outstanding medical bills. Meanwhile, consumers who were enrolled in American Benefit Plans must act quickly to obtain new coverage. In many cases, federal and state laws offer some protections to these individuals seeking to change health insurance coverage; however, most of these protections are time limited. The consumer alert summarizes protections consumers may have and directs readers to appropriate authorities to contact for more information.

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Legislation is being debated in Congress and in some states to promote the sale of health insurance through associations. Some of these proposals would weaken the regulation of association health plans, relative to current law. The experience of American Benefit Plans shows how important it is to establish and enforce effective protections for consumers who purchase such health coverage.

This issue brief was prepared by Mila Kofman, JD

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