Individual Health Insurance
For those of us with any sort of pre-existing medical condition,
too young to qualify for Medicare Benefits, doing just a little
too well to qualify for a Medicaid Plan, too broke to afford a
steep out-of-pocket privately sponsored health care premium or
too "self-employed" to be a participant in an affordably-priced
group sponsored medical program, today's health-insurance marketplace
can seem a bit daunting and more than a little inaccessible to
say the very least. Though none of the factors listed above has
the capability to keep consumers from getting health insurance
coverage through one of the nation's major indemnity carriers
in and of itself, they do work to hamper the efforts of sixteen
million or so of us searching for a private health policy to buy
into that won't be prohibitively expensive.
The need to buy into a health insurance plan of our own
makes us the proverbial "unwanted children" of the medical insurance
marketplace . . . The employees of smaller firms unable or unwilling
to offer healthcare benefits, the self-employed, those of us who
are lingering between jobs, recently divorced or widowed individuals
whose situation has lost them their spouse's group health coverage,
young adults who've moving or being moved off of their parents'
medical policies or those of us who've decided to retire early
and thereby lose our group health coverage before turning sixty-five
and becoming eligible for Medicare . . . are all faced with the
need to buy into an individual or family policy and entering
into a peril-fraught marketplace wherein both good advice and reasonable
prices can be scarce.
There are fewer and fewer major health insurers interested in
offering their services to individuals such as those described
above, and their reasons for that are fairly straightforward.
With employer paid group care policies, both the company's sicker
and their healthier employees are mixed into the same risk pool,
and the premiums paid by the healthier individuals tend to cover
the costs of the claims of the ill. But with an individual health
plan, there isn't an alternate revenue stream subsidizing a participant's
care needs. And, as a direct result, many health providers claim
that even their ever higher premium charges aren't sufficiently
covering the costs of medical care when an individual policyholder falls
ill or has an accident. Many carriers either try to avoid directly
writing health policies for the individual market, or try and employ
strategies designed to limit their risk as well as individual consumers'
access to the coverage for the healthcare they need.
None of which means that there aren't good deals out there, but
rather that they may vanish once individuals are sick or get injured
and file a claim. Just as with any other marketplace, effective
comparison shopping is key, but there also a few things that individual
health care consumers can look out for as they struggle to get
and stay insured:
- COVERAGE FOR PRE-EXISTING ILLNESS - The majority of individual
care policies are medically underwritten. What that means is
that some providers take a closer than average look at applicant's
medical records then turn down those individuals with health
conditions considered to pose too much of a risk. While its not
odd that most insurers would deny coverage to an individual with
a serious condition such as cancer or coronary artery disease
or diabetes, but consumers faced with the sort of benefits provider
who also turns down applicants suffering from ailments as minor
as ear infections or hay fever will want to look elsewhere for
care.
- GAPS IN THE REGULATIONS - There are a small number of insurance
carriers offering healthcare plans that appear to be group benefits
when they aren't. Providers arrange for a master benefits policy
under the auspices of what's known as a "group discretionary
trust," in states where there are few if any regulations governing
the kinds of health policies that individual consumers may be
sold therein. Such carriers then offer health coverage in other
states, but said policies are solely governed by the lackluster
laws of the state holding the master policy. Consumers faced
with business practiced in such a fashion can only be advised
to keep looking for a reliable healthcare carrier.
- THE CRACKS IN THE SYSTEM - In 1996, when the Congress passed
the Health Insurance Portability and Accountability Act or HIPAA,
they mandated that every state provide a source of last resort
for individuals to buy into a health insurance plan. Unfortunately,
HIPAA really didn't come too close to solving the health care
system's problems and in actual fact left a dismal market-place
virtually unchanged. HIPAA laid out a set of minimum standards
for coverage of last resort, but did not ensure that anyone who
needed health insurance coverage would have access to a policy
irregardless of their health status. The resulting hodgepodge
of insurance regulations that vary from state to state has left
consumers with the need for unbiased sources from which to both
their health plan quotes and their health care information.
It's a difficult truth that the individual health insurance marketplace
offers consumers few if any teammates with which they can spread
out the risks and overall costs of paying for health and major
medical care, and individuals who require coverage are often burdened
by self-employment, expensive pre-existing health conditions or
age group and indemnity carriers do not typically do business in
a manner designed to sell policies at a loss. Consumers require
more than simply a piecemeal slate of reforms to confront and solve
the substantial problems facing them as they search for health
insurance coverage. What they clearly need is a place, an impartial
information portal, where they can let the nation's health system's
most consistent asset, its sheer competitiveness, work for them
rather than against them and get the help and reliable quotes they'll
need to find the insurance they need.
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