Health Insurance Consumer Information

Congressional Quarterly reports on a recent study from the American Enterprise Institute, evaluating different hypothetical scenarios that would allow people to purchase health insurance across state lines. The AEI found that if individuals were allowed to purchase health policies in nearby state, up to 12 million more people would leave the rolls of the uninsured. This supports the organization’s general contention that increased competition and less regulation for businesses, is good for consumers.

However, the results raised serious questions for many health policy researchers, who noted that inexpensive “policies” often don’t cover basic health care needs for consumers.

Karen Pollitz, the Georgetown University professor who runs healthinsuranceinfo.net,  reacted to the findings:

“[Saying that policies that don't cover a consumer's health needs are cheaper than those that do is] like saying a roller skate is cheaper than a car. … Good health insurance that will take care of you when you’re sick is expensive because health care is expensive. … The regulations [in states that have them] require that the insurance be meaningful.”

Click here: Congressional Quarterly’s story.

Insurance for the self-employed and others on the individual market can be expensive and difficult to obtain, as reported by Julia Appleby of USA Today.

Unlike group plans offered by employers — which provide coverage to everyone, no matter how sick — there is no guarantee in most states that individuals can get insurance. Even if they can, their policies may not cover existing medical conditions such as hay fever, depression or pregnancy.

The article cites a 2001 study from the Kaiser Family Foundation, authored by Karen Pollitz of Georgetown University’s Health Policy Institute.

In a 2001 study by Karen Pollitz of the Georgetown Health Policy Institute, researchers submitted applications to 19 insurers on behalf of seven fictitious applicants, who had medical conditions ranging from HIV to allergies. Of 420 applications, 37% were rejected.

“What we have shown is there are carriers who will turn you down if you have hay fever,” Pollitz says.

Read the USA Today story: Individual health policies leave many behind

The Kaiser Family Foundation’s report, How Accessible is Individual Health Insurance for consumers in less-than-perfect health? is available as a free download from the KFF website. You can read the four page executive summary, or the 62 page full report.

It turns out that 7 percent of Americans would, and that they might be making the right choice.

Freelancer Michelle Goodman has written for ABC News about her own adventures in obtaining health insurance, and the sad news for her and others is that as an independent contractor, the price of buying an individual policy comes to thousands of dollars per year. As a result, some couples are rushing to the altar so that the one with employee benefits can bring the other onto their policy.

Even sadder are the stories of those who get divorced, or choose not to get married, so that a child or a sick individual will be able to qualify for a low-cost health care policy available on a low-income basis.

Goodman’s story offers several resource links for those who decide not to let their health insurance status determine their love lives, though she acknowledges that the choices are few and usually quite expensive.

Read the stories of the dental-care elopement; the 21st-century married “friends with benefits,” as in health benefits; and the Medicare divorcee, on the ABC News website: Getting Married for Better Health Coverage and Other Tales from the Insurance Mess.

Debt-Free on $32,000 a year? Why, yes!
… But there’s a catch: it’s only if you’ve got employer sponsored health insurance.

Have you been clipping coupons, cutting up credit cards, resetting the thermostat? All are great ways to save money.  And, as Parade magazine reports this week, one of the single most-effective ways to eliminate debt and take control of your financial life, is to get a job that has a generous employer-sponsored health plan.

Reporter Lynn Schnurnberger follows two families who are so frugal they let their lawns go brown, cut each others’ hair, and don’t own cell phones.  Jim Schenke, his wife Shauna and their two daughters are even living on an income of $32,000 per year, in large part because:

Jim picked his job at a university because it pays 90% of his family’s health insurance.

But not everybody, unfortunately, has this option. If you’ve been downsized, or gotten a divorce, or recently graduated, you probably can’t rely on an employer’s health insurance package right now.

So, what should you do? Where to turn entirely depends on where you live, as each state offers different protections for health insurance consumers going it alone or working for a small employer.

On this website, you’ll find valuable, clear information to help you get or keep health insurance, even though you won’t be saving money like the Schenkes can.

From the healthinsuranceinfo.net front page, choose your state from our map, and you’ll be taken to the FREE online Guide to Getting and Keeping Health Insurance where you live.

We’ve also got a great, FREE series on Managing Medical Bills which you can download here. The guides cover:

1. Private Health Insurance
2. Medicare and Medicaid
3. Medical Debt

“Employers that offer good coverage by and large will pay the lion’s share of the premiums on your behalf,” says health insurance expert Karen Pollitz of Georgetown University. “You’re probably not going to find a better deal than that.”

Professor Pollitz was quoted in the June 22nd article “What to Do When Your Health Insurance Runs Out,” in The Washington Post, by Leah Ariniello.

Did you lose your job, or are you thinking about leaving your job or school in order to go out on your own? Ariniello’s Washington Post article gives lots of health insurance tips for individuals who have to buy their own policies.

Our consumer guides, cited in the article, will help you figure out whether you’re eligible for financial help in your state, and what other protections you have in the individual health insurance market.

Read our consumer guides to the protections you have and lack when you are buying insurance in your state.

Aliza Marcus of Bloomberg.com reports on the case of Kendra Dyer, the Oklahoma girl whose private insurer decided to stop covering her care when she was 18 months old.

Karen Pollitz, director of the Health Policy Institute at Georgetown University is quoted in the story:

Our private insurance routinely fails people when they get sick … The market needs to be cleansed.

Fortunately for Kendra, Oklahoma has a state-funded high-risk pool that Kendra, now 6, is covered under. But only 34 states offer high-risk pools and few provide coverage to all who are eligible.

Does your state have a high-risk pool? Read our list of states which includes contact information for your state’s pool.

Are you about to lose coverage? Each state has different laws that apply to your ability to get and keep health insurance. Visit the front page of our website and click on your state on the map for a comprehensive free guide to your options in your state.

Are you in Oklahoma, like Kendra? Here’s our free Oklahoma guide.

Amy Harmon of the New York Times writes today about Congress’s overwhelming vote on May 1, for a bill that prohibits discrimination by health insurers and employers based on a person’s genes.

This Genetic Information Nondiscrimination Act protects consumers and prevents insurance companies from using genetic information to deny benefits or raise premiums for individual policies, and prevents employers from hiring, firing or setting compensation based on genetic information.

The implications of this bill, should it become law, may continue to have a positive impact on the healthcare situation for all Americans. The story quotes Karen Pollitz, director of the Health Policy Institute at Georgetown University and head of the healthinsuranceinfo.net project:

“Ultimately unlocking all these genetic secrets will make the whole idea of private health insurance obsolete.”

Read the story online: Congress Passes Bill to Bar Bias Based on Genes, New York Times, May 2, 2008.

For more background information, Professor Pollitz’s 2007 paper, Genetic Discrimination in Health Insurance: Current Legal Protections and Industry Practices, from the journal Inquiry, is helpful.  You can order back copies from Inquiry via the link above.

Two recent stories in the New York Times featured the healthinsuranceinfo.net website and its free consumer guides. Whether you are self-employed or facing retirement, these articles can provide some advice and perspective on your situation and stories of others in your situation.

Before Medicare, Sticker Shock and Rejection by Fred Brock, April 21, 2008. Pointing out that only a third of employers now offer retiree health benefits, the article discusses some of the technical aspects of getting health insurance if you retire before you are eligible for Medicare and can’t afford COBRA rates for your employer’s health insurance, covering topics like guaranteed issue, premiums and deductibles, some of the ins and outs of COBRA and HIPAA, and high-risk pools.

The article states: “If you have no pre-existing medical conditions (however that is defined by your prospective insurance company), buying individual insurance should not be hard in a state without guaranteed-issue laws.” healthinsuranceinfo.net provides current information on state insurance rules.”

Finding Health Insurance If You Are Self-Employed by Marci Alboher, March 27, 2008. “These [state-by-state consumer guide] primers are comprehensive and frequently updated, and they are a great place to start, especially if you have been wondering about the meaning of jargon that peppers insurance providers’ descriptions of their offerings,” according to Alboher and one of her subjects, Jennifer Jaff.

Georgetown University’s Health Policy Institute has updated its Consumer Guide to Getting and Keeping Health Insurance in Arizona as of March 2008.

The guide contains important consumer information regarding state-based protections and health insurance policy options, including HealthCare Group of Arizona, KidsCare, and the Well Woman HealthCheck Program.

Coverage rights and limitations for COBRA, Medicaid and the Federal Health Coverage Tax Credit (HCTC) are also outlined.

Arizona, like other states, offers its own protections for individuals who are buying private individual health insurance, and these protections (and the limitations on them) are well-explained in this guide.

Get your free copy now, in downloadable PDF format, or skim the guide online: healthinsuranceinfo.net/getinsured/arizona

Mila Kofman, Supervisor of the Maine Bureau of Insurance and Georgetown University Professor, weighs in on one young professional’s question about choosing a health insurance plan.

He says: “my parents are all over me to get insurance (I make $47,000 a year) so I told them I’d look into it. What should I look for?”

See Kofman’s response at Qvisory.