Need health insurance? Better get to work
Do research to find the best individual plan
By Jane Glenn Haas
THE ORANGE COUNTY REGISTER
If you are too young for Medicare but considering leaving a job that offers
group health insurance, it pays to do some research.
After a yearlong investigation, Consumer Reports has concluded that 89 percent
of the people younger than 65 who look for individual health insurance do not
buy it because it is too costly, because they are turned down for health reasons
or because benefits are inadequate.
"Private insurance is virtually out of the question for 76 percent of uninsured
Americans -- and those who do have insurance told us wrenching stories about the
high costs and poor coverage they receive," says Nancy Metcalf, health editor at
Consumer Reports.
She calls searching for private insurance "daunting" and a challenge to any
adult who hopes to retire early, loses a job, is self-employed or has an adult
child leaving a group plan.
"The nature of health insurance is that the only people profitably to insure are
those who are healthy," Metcalf says.
Question: Why can a person get coverage in one state but not in another?
Answer: The insurance industry is regulated on a state-by-state basis. There is
no uniformity. There are enormous differences in disqualifying medical
conditions.
Q: You cite PacificCare, which might exclude anyone who takes prescription
medications for high blood pressure, acid reflux, asthma, migraines, arthritis.
Aetna won't insure anyone who has had a hip or knee replacement. Other insurers
have equally onerous health hurdles. Some of those conditions are tough to avoid
after 50. What alternatives do we have?
A: It is very shocking to a lot of people. There is no good answer for the way
the individual insurance system works today. People just don't realize they are
only paying 25 percent or 30 percent of the premium when they have group
insurance. Consumer Reports found that the median out-of-pocket medical expenses
for the last 12 months were $2,264 for those with individual insurance vs. $973
for those with employer-based plans.
Q: You have many tales of insurance woe in your article. What's a person to do?
A: Start by going to www. healthinsuranceinfo.net to check out coverage in your
state. You really need to be careful leaving a group plan. There is a little
window for coverage.
The federal Health Insurance Portability and Accountability Act provides some
protection if you are switching from job-based group coverage to an individual
plan even if you have a medical condition that could preclude insurance.
But to exercise your HIPAA rights, you first have to exhaust all job-based
coverage available, including COBRA, which allows you to continue in your
employer's plan for 18 months by paying the full cost plus 2 percent.
HIPAA is like a get-out-of-jail-free card for people with pre-existing
conditions. But you must apply for individual coverage within 63 days after your
old coverage ends.
Every state has to make sure there is at least one policy available to you if
you meet these conditions.
Q: Other suggestions?
A: Know your state laws.
Q: What are other ways people can educate themselves?
A: Go to www. consumerreports.org/health for unbiased comparisons and
www.eHealthInsurance.com for links to hundreds of insurance plans across the
country.
