Third Report About America's Health Care Crisis With 6 Tips For Buying
Individual Insurance
YONKERS, N.Y., Dec. 3 /PRNewswire-USNewswire/ -- Consumer Reports' yearlong
investigation into health insurance explains the huge hurdles that consumers,
including healthy people with minor ailments, face when they try to acquire
health insurance on their own.
According to research cited in the report, 89 percent of people who looked
into buying individual insurance had not bought it because it was too costly,
they were turned down for health reasons, or it provided inadequate benefits.
The report, "On their Own," is featured in the January issue of Consumer
Reports, on newsstands December 4 and available online at
http://www.ConsumerReports.org/health where CR maintains a health insurance
hub for consumers. The report is the third in a series on America's health
care crisis.
FIXING THE PRIVATE INSURANCE MARKET: THE HURDLES
"What we've learned in our investigation is that private insurance is
virtually out of the question for most uninsured Americans -- 76 percent to be
precise -- and those who do manage to acquire insurance on their own tell us
wrenching stories about the high costs and poor coverage they receive," said
Nancy Metcalf, health editor at Consumer Reports. People in need of private
insurance face a daunting dilemma--buying limited health insurance at a high
cost or foregoing 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.
CLOSE UP: INDIVIDUAL COVERAGE, MORE COMPLAINTS
Source: Consumer Reports National Research Center
INDIVIDUAL PLAN EMPLOYER PLAN
Overall complaints with coverage 71% 53%
Insurance covered most costs 55% 81%
Premium is too high 52% 29%
Postponed needed medical care
because of costs 45% 31%
Deductible is too high 41% 28%
Does not adequately cover costs of
doctor visits 26% 16%
According to Metcalf, the latest nationally representative survey conducted by
the Consumer Reports National Research Center underscores the level of
discontent of the 7 percent of Americans who manage to obtain individual
coverage. "If we're going to rely on individual insurance to fix our health
care system, it needs a major overhaul," continued Metcalf.
DISQUALIFYING MEDICAL CONDITIONS
The "world of pain" described in the Consumer Reports investigation hones in
on the enormous differences that exist in state regulations of individual
insurance plans. A person who could easily buy insurance in one state could
be shut out of the market in another. Most striking is the long list of
health conditions that could result in being declined coverage, even for such
common conditions as hay fever and acid reflux.
Medical underwriting, a practice in which insurers can reject people with
illnesses, is the reason why, explains CR. Michael Miano, profiled in the
report, learned that he was uninsurable because he had diabetes. Miano's case
represents one of the most significant problems in the individual insurance
market. While it's illegal for insurers to discriminate against people in
group plans because of their health, medical underwriting is allowed in all
but a handful of states.
Some prominent examples of medical underwriting:
-- Health Net lists diabetes, once diagnosed, as a "declinable condition."
-- PacifiCare may decline anyone who takes prescription medications for high
blood pressure, acid reflux, asthma, migraines, arthritis, or depression.
-- Aetna won't insure anyone who's had a hip or knee replacement.
FIXING THE SYSTEM: CU's TAKE
Several presidential candidates propose tax incentives for people to buy
individual insurance. Consumers Union, the nonprofit publisher of Consumer
Reports, opposes that approach because it does nothing to fix the underlying
problems, such as medical underwriting, and the tax breaks wouldn't be enough
to make insurance affordable for people with lower incomes.
Other candidates propose to expand coverage by bringing more people into the
risk pools, by, among other things, requiring insurers to cover everyone
regardless of health history, and subsidizing premiums for lower-income
consumers. Consumers Union believes that those are more promising approaches,
so long as they are coupled with vigorous efforts to control costs, eliminate
waste, and encourage better coordination of care for chronic conditions.
TIPS FOR BUYING INDIVIDUAL INSURANCE
(Log on to http://www.ConsumerReports.org/health for more detail)
Know Your State Laws: Log on to http://www.healthinsuranceinfo.net for
information about state rules outlined by the Georgetown University Health
Policy Institute.
Be Careful Leaving a Plan: Consumers should be sure to exercise their rights
under the federal Health Insurance Portability and Accountability Act (HIPAA).
Research the Market: Check out http://www.ehealthinsurance.com, a reputable
Web site with links to hundreds of individual plans nationwide. Consumers
should also check their state's insurance department Web site, which might
have a list of companies licensed to sell 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.
Look Beyond The Premium: The real costs of an insurance plan include the
monthly premium, the annual deductible, and the copays for office visits and
prescription drugs.
Keep Looking: Thirty-four states maintain high-risk pools for people who can
not pass medical underwriting--though consumers can't count on hearing about
that from a broker or private insurer.
JANUARY 2008
The material above is intended for legitimate news entities only; it may not
be used for commercial or promotional purposes. Consumer Reports(R) is
published by Consumers Union, an expert, independent nonprofit organization
whose mission is to work for a fair, just, and safe marketplace for all
consumers and to empower consumers to protect themselves. To achieve this
mission, we test, inform, and protect. To maintain our independence and
impartiality, Consumers Union accepts no outside advertising, no free test
samples, and has no agenda other than the interests of consumers. Consumers
Union supports itself through the sale of our information products and
services, individual contributions, and a few noncommercial grants.
SOURCE Consumer Reports
Tildy La Farge, +1-914-378-2436, mlafarge@consumer.org or Lauren Hackett,
+1-914-378-2561, lhackett@consumer.org, both of Consumer Reports
