Health Insurance Consumer Information

US News and World Report published a story earlier this week quoting project director Karen Pollitz, which uncovered the unsavory hard truths about health insurers who deny coverage for pre-existing conditions, and deny policies based on pre-existing conditions.

As Pollitz notes, some in the business community say that pre-existing condition exclusions may be intended to encourage people to get insure before they are sick, rather that waiting until they are sick when their conditions will cost insurers more.

“It’s a penalty for waiting to get insurance,” says Pollitz. “But a lot of people didn’t wait. They had coverage, and they lost it.”

The article also contains advice to consumers about keeping group health insurance if at all possible.

Read it at the US News and World Report website: Health: An Ailment Could Delay or Rule Out Healthcare Coverage.

Mila Kofman, Associate Research Professor at Georgetown University’s Health Policy Institute, was quoted in a Wall Street Journal story on one Utah company’s proposal to market discriminatory health insurance practices to US businesses.

Commenting on the entrepreneur’s business idea, which is that employers should drop group health insurance coverage for their employees and instead provide individual insurance policies for eligible employees, Kofman said:

“I think this is blatantly illegal … I would not advise any employer to do this.”

Read the story online: Employers Turn to Alternative for Insuring Staff.

Karen Pollitz, Project Director of the Health Policy Institute at Georgetown University, spoke to USA Today about a new set of high-deductible health care plans being offered by United Healthcare and others.

These plans offer financial incentives, in the form of significantly lower deductibles, for enrollees who submit to health tests that show they fall into generally healthy standards. This is advertised as promoting healthy lifestyles which in turn can lower illness rates in some categories. But do the damaging consequences to privacy and potential discrimination against the less-than-healthy, outweigh the benefits?

“A key protection in the Americans with Disabilities Act is that your employer can’t discriminate against you based on health status,” says Karen Pollitz at the Georgetown University Health Policy Institute. “They can’t even ask about your health, with the only exception being if they ask through a voluntary program. You could argue that this program is not voluntary.”

Read the story at the USA Today website: Plan bases deductible on health tests, sees costs fall.

Assistant research professor Mila Kofman of Georgetown University’s Health Policy Institute was quoted in an Associated Press story about the increasing numbers of hospital patients and health care consumers who use the web to research medical costs and healthcare quality.

Noting that hospitals rarely put the actual charges that insurers pay on their web sites, Kofman is quoted as saying: “There is a certain level of faith that we have to put in other experts to help us make decisions … I think if I was sick, I would want my physician to make recommendations on proper course of treatment.”

healthinsuranceinfo.net has published guides about medical bills and medical debt, which you can download for free online: Managing Medical Bills: Strategies for Navigating the Health Care System

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

Karen Pollitz, project director for Georgetown University’s Health Policy Institute, spoke on a Kaiser Family Foundation panel about current health insurance coverage for families, pregnant women and newborns, and about current proposals that may change the way maternity charges are covered.

Speaking about consumer-driven health plans, or “CDHPs,” Pollitz was quoted as saying:

“[The medical cost of pregnancy and delivery] is an issue that consumers struggle with from time to time with health insurance regardless of what kind of plan you have … But the stakes are higher with these CDHPs because if you’re wrong or you have a claim you’re on the hook for so much more money.”

Pollitz offers guidance for those looking at family coverage options from health insurers, covered in an article from Dow Jones’s MarketWatch. Read it here: 10 things to consider about your insurer’s maternity coverage.

Read the full report, available at the Kaiser Family Foundation website: “Maternity Care and Consumer Driven Health Plans.”

Read the Washington Post’s coverage of the report: High-Deductible Plans Cost More for Maternity Care

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/managing-medical-bills/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.

Georgetown University Health Policy Institute Project Director Karen Pollitz appeared as a guest on “Talk of the Nation” on May 11, 2007, on National Public Radio. The show covered recent developments in the health care reform movement in the United States. With 45 million Americans uninsured, this hot topic continues to receive close scrutiny from the authors and experts who provide information on your rights as a health care and insurance consumer, at healthinsuranceinfo.net.

You can read more and listen to the radio show on the NPR website: www.npr.org/templates/story/story.php?storyId=10136885.

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

Periodically, our experts at healthinsuranceinfo.net receive questions from consumers who are looking for guidance in the health insurance market. This question came to us recently.
Question: I am 59 years old and my wife is 54, our Cobra policy will be ending in September. Where do we go from here after our Cobra expires? Thanks for your assistance.

Answer: If you have exhausted COBRA and met other requirements, you will be ‘HIPAA eligible’ for coverage as an individual. HIPAA eligible means that all of the following are true:

• you have 18 months of creditable coverage, the last day of which was group coverage,
• you have exhausted any COBRA or state continuation coverage you are eligible for,
• and you have not had more than a 63 day break in coverage.

Being federally eligible means that you have guaranteed access to individual health insurance coverage and will not be subject to any pre-existing condition exclusion periods.

Each state uses different methods to guarantee your access to coverage. Some states require individual health insurers to cover you while others may guarantee you high-risk pool coverage. Your state may use different options from these.

For more information about buying health insurance in your state, see our Consumer Guides to Getting and Keeping Health Insurance, available at healthinsuranceinfo.net.