Health Insurance Consumer Information

Georgetown University’s Health Policy Institute has just released its latest FREE guide for consumers in the market for health insurance: Consumer Guide to Getting and Keeping Health Insurance in Massachusetts.

This guide includes important NEW information for Massachusetts residents related to recent changes in the law. Beginning July 1, 2007, all Massachusetts residents must obtain and maintain health insurance. Individuals who cannot show proof of health insurance coverage will lose their personal income tax exemption and face significant tax fines.

Consumers, legislators, researchers, policy experts and social workers will all find this 49-page guide to the protections consumers have, and lack, as they seek health care coverage, of use. Download the guide now.

The Health Insurance Consumer Guides for Tennessee and West Virginia have been recently updated and posted to our website, where you can get them for no charge.

Click on the link below to go to the appropriate guide:

TENNESSEE

WEST VIRGINIA

Tags: health insurance, tennessee, west virginia

healthinsuranceinfo.net has just revised its list of State High Risk Insurance Pools with the latest contact information for each, available on our website at: www.healthinsuranceinfo.net/nefe/high_risk_pools_chart.htm

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.

We strive to keep this information as current and useful as possible. If you know of any changes or updates, please leave us a comment below!

Check the list now.

Tags: medical costs, health insurance, high risk pools

Georgetown University’s Health Policy Institute has released updated Consumer Guides for South Carolina and Nevada.

Health insurance consumers, legislators, social workers and advocates use these guides for clear, comprehensive information on the rights that consumers have, and lack, as they enter the health insurance market in their state.

These guides are available in their entirety, for free, on this website in PDF format; see our copyright notice for reprinting and redistribution guidance.

• South Carolina Health Insurance Consumer Guide

• Nevada Health Insurance Consumer Guide

Tags: health insurance, health care costs, medical costs, South Carolina, Nevada

Georgetown University’s Health Policy Institute has released updated Consumer Guides for Florida and Iowa, as of January 2007.

Health insurance consumers, legislators, social workers and advocates use these guides for clear, comprehensive information on the rights that consumers have, and lack, as they enter the health insurance market in their state.

These guides are available in their entirety, for free, on this website in PDF format; see our copyright notice for reprinting and redistribution guidance.

• Florida Health Insurance Consumer Guide

• Iowa Health Insurance Consumer Guide

The December/January 2006 issue of Health Affairs, a Health Policy Journal, includes an article by our researchers:

Association Health Plans: What’s All The Fuss About?
The presumption that association health coverage has more market clout is not necessarily borne out by the evidence.
by Mila Kofman, Kevin Lucia, Eliza Bangit, and Karen Pollitz

ABSTRACT: Policy makers have tried to address the problem of the uninsured and to help small businesses with rising premiums by encouraging associations to offer coverage. Although supporters and opponents have made claims about the potential impact of this strategy, the association market has not been studied in depth. Examining current standards might explain why proponents seek changes. This paper discusses states’ approaches to regulating health insurance offered by associations, including “self-insurance,� as well as existing state exemptions from state insurance laws that otherwise would apply to coverage sold to small businesses, self-employed people, and individual purchasers. We also examine market problems such as insolvency and fraud.

Three new consumer guides offer important information for people seeking to get and keep health insurance or trying to cope without it. MANAGING MEDICAL BILLS: Strategies for Navigating the Health Care System is a series of three booklets sponsored by the National Endowment for Financial Education (NEFE) and authored by researchers at Georgetown University Health Policy Institute. These consumer guides help people understand the insurance coverage they have, explore avenues for obtaining new private or public coverage when the need arises, and identify options that may help with medical bills when both private and public coverage options fail.

“Navigating insurance transitions and problems can be confusing, even treacherous, especially for people with serious health care needs,� observed project director Karen Pollitz. “Gaps occur when coverage is not available or adequate or affordable, or when it’s just too hard to find and use. The medical and financial consequences can be devastating. Policymakers need to make it as easy to get health insurance coverage as it is to lose it. They need to find ways to make insurance more affordable without sacrificing coverage adequacy.�

The first booklet, “Understanding Private Health Insurance,� offers tips for evaluating the adequacy of private insurance options and summarizes laws that protect consumers with health problems when they transition from one plan to another.

The second booklet, “Medicare and Medicaid: A Health Care Safety Net for People with Serious Disabilities and Chronic Conditions� outlines coverage assistance offered by these government programs, including eligibility requirements, covered benefits, and federal and state agencies to contact for more information.

The third booklet, “Options for Avoiding and Managing Medical Debt,� discusses possible sources of free and reduced cost care and their limits, and provides an overview of recent changes in the bankruptcy system that may restrict this option for people with mounting medical debts.

These publications are available free of charge and can be obtained online at www.healthinsuranceinfo.net/nefe, and on the National Endowment for Financial Education consumer website, www.smartaboutmoney.org.

Researchers at Georgetown University Health Policy Institute, working in partnership with the American Diabetes Association (ADA), just completed a report on health insurance problems of people with diabetes. “Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes,” reviews the experiences of 851 people who called the national call center for help with their health insurance problems. Only 1 in 5 callers could be helped.

Case studies from the report are described along with national survey research findings that indicate people with chronic conditions are disadvantaged in health insurance in the U.S. Specifically, people in poor health who lose health insurance tend to be uninsured longer compared to healthy people; and medical debt and medical bankruptcy increasingly are problems of the insured.

Stories of real people in the report add important detail to what is already known. Problems studied were resolved when people could find health coverage that was simultaneously available, affordable and adequate. For most, however, health insurance and other safety net protections — such as COBRA and high-risk pools — often met only one or two of these three requirements, and so did not help. In particular:

• Individual health insurance — 395 people needed coverage in this market but only 15 could buy policies
• COBRA – 377 people lost or were losing job based coverage but only 31 took COBRA
• HIPAA — 87 people were HIPAA eligible but only 11 bought HIPAA coverage
• High-risk pools — 344 people needed coverage and lived in high-risk pool states but only 7 enrolled

The report identified features of health insurance coverage that make it harder for people with diabetes to get and keep coverage during insurance transitions. Barriers to finding new coverage included:

• medical underwriting in individual insurance,
• lack of COBRA premium subsidies for people who lose jobs,
• insurance premium surcharges based on health status, and
• pre-existing condition exclusion periods in high-risk pools.

In addition, people whose health insurance was not changing also had problems — most often they were under-insured. When insurance did not cover test strips or prescription drugs, or when it imposed high-deductibles and other cost sharing, people had trouble getting care necessary to manage their diabetes. Medical and financial consequences of these problems could be severe. In a number of cases, people developed preventable complications requiring hospitalization and/or amassed medical debts they could not afford to pay. The report concluded that the perspective of people with diabetes — or other serious, chronic health conditions — provide an important lens through which to evaluate health insurance. Proposals to change the coverage system need to be considered in light of their impact on sick people.

Click here to read the full report (PDF format, 53 pages, 430 KB) or the executive summary (PDF format, 8 pages, 48 KB).

The press briefing releasing this report can be viewed (with transcript available) at www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1357

This project was supported by grants from the W.K. Kellogg Foundation, the Robert Wood Johnson Foundation, the Commonwealth Fund, and the American Diabetes Association.

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