Health Insurance for One
By Morgan Kelly
Staff writer
Without an employer to cushion the blow, the price of individual health insurance can hit an independent buyer rather hard.
“If all of us had to have it, we’d probably be lucky to get it for a couple thousand a month,” said Debbie Kimble of Charleston’s Peanut Shoppe. Fortunately, the store’s three employees — all family — get coverage through spouses or the government.
“Anytime you have to put an extra $2,000 out, it’ll be harder,” she said. “But that’s when you tighten up your belt and cut back somewhere else.”
Although independently sought policies do not fall into most people’s view of reasonable, the average person can buy health coverage without breaking the bank as long as they can part with the usual workplace benefits, insurance experts say.
“If you’re young, the premiums can be relatively modest, but you’re talking about the deductibles in that market being $1,000 sometimes,” said Gary Claxton, director of the Kaiser Family Foundation’s Health Care Marketplace Project.
“You’re not going to get what most of us call a good policy for not a whole lot of money, but you can avoid making mistakes.”
First of all, avoid being roped in by your own health problems, Claxton said. Some insurers won’t sell to people who are already sick. Even if you do manage to secure a policy, there are several ways you can still be left uncovered when you can least afford it.
In West Virginia, insurers can set your premiums based on your health by 30 percent more or less than the standard cost, said Jessica Waltman, director of health policy research for the National Association of Health Underwriters, or NAHU, an insurance trade group.
“The rate you see online is the best-case-scenario rate,” she said.
Companies can also look at your health for the last year and refuse to cover conditions you had before applying for the policy, or pre-existing conditions, Waltman said. These conditions can go on for up to two years.
The point, of course, is to keep people from getting insurance just because they are sick, Waltman said.
But these exclusions can be somewhat arbitrary, said Trudy Lieberman, director of the Center for Consumer Health Choices, part of Consumers Union, which publishes the magazine “Consumer Reports.” A case of asthma could lead an insurer to deny all claims involving respiratory illnesses.
“These can be very minor problems, but you’re still not wanted by insurance providers,” Lieberman said. People looking for a policy should contact a broker who represents more than one company to get a good variety of choices.
The point of group- or work-based insurance is to spread the cost out over a large group of people, Waltman said. The larger the group, the less everyone pays (more or less the principle behind national health coverage). The idea is that if someone gets sick, there will be money flowing in to cover that person’s health needs.
On the other hand, when a single person or a small family gets a policy, the risk of illness shoots up while the chance of having enough cash to cover your health expenses goes down. Therefore, the policy costs more, Waltman said.
Plans employers buy — particularly those with good benefits — are more expensive than the average individual plan, but the employer fronts a lot of the cost, she said.
“It’s not that the [individual insurance] costs more. It’s just what people are used to paying out of pocket themselves,” she said. “Medical costs are still the same. Most people don’t realize what employers were paying for them.”
Until they try to pay for that policy themselves, that is. The Consolidated Omnibus Budget Reconciliation Act, or COBRA, lets people stay on a company’s insurance plan for a year and a half as long as they pay the premium themselves. Premiums can increase by several thousand dollars.
“COBRA is really a rock and a hard place,” Claxton said. “It’s usually too expensive, but it’s good coverage.”
Employees who opt for COBRA can eventually buy an individual policy without worrying about pre-existing conditions, their age or their health, Lieberman said. But you have to stay with your COBRA policy to the very end of its life. You could lose thousands before you start to save anything.
More people are being pushed into the private market as health-care costs skyrocket and employers trim back on health benefits, she said. For older employees, this can mean the inevitable ailments of age become a huge problem, Lieberman said. “The individual market is a pretty dark place.”
As the only employee of Charleston’s Shear Cut barbershop, John Ciampanella would need individual health coverage if not for his wife’s work-based insurance. (In West Virginia, a small business, for insurance purposes, means two to 50 employees, according to NAHU’s Web site.)
With his diabetes, he would be a tough sell to an insurance company.
“If you’ve got diabetes, no insurance company will take you on,” he said. “If I didn’t have [my wife’s insurance] I’d probably be up there standing in line for free shots.”
West Virginians who have been turned down for insurance because of chronic problems like diabetes can join AccessWV. Known as a “high-risk pool,” the rates and deductibles are a tad higher than the state average because mostly everyone in the plan is sick.
For instance, if the average rate is $100, the AccessWV rate would be $125, Waltman said.
On the opposite spectrum, people in good health could consider a health savings account. People going this route buy a cheap policy with a high deductible ($1,000 to $2,700 for individuals), Waltman said. Each year, the account holder can deposit money into the account up to the amount of the deductible.
The theory is that you’ll have a lot of money saved for medical care if you want it or need it. Unfortunately, it really only works if you never get sick, Lieberman said.
“They’re a gamble,” she said. “How many people can say they’ll never get sick? We don’t know.”
Staff writer
Without an employer to cushion the blow, the price of individual health insurance can hit an independent buyer rather hard.
“If all of us had to have it, we’d probably be lucky to get it for a couple thousand a month,” said Debbie Kimble of Charleston’s Peanut Shoppe. Fortunately, the store’s three employees — all family — get coverage through spouses or the government.
“Anytime you have to put an extra $2,000 out, it’ll be harder,” she said. “But that’s when you tighten up your belt and cut back somewhere else.”
Although independently sought policies do not fall into most people’s view of reasonable, the average person can buy health coverage without breaking the bank as long as they can part with the usual workplace benefits, insurance experts say.
“If you’re young, the premiums can be relatively modest, but you’re talking about the deductibles in that market being $1,000 sometimes,” said Gary Claxton, director of the Kaiser Family Foundation’s Health Care Marketplace Project.
“You’re not going to get what most of us call a good policy for not a whole lot of money, but you can avoid making mistakes.”
First of all, avoid being roped in by your own health problems, Claxton said. Some insurers won’t sell to people who are already sick. Even if you do manage to secure a policy, there are several ways you can still be left uncovered when you can least afford it.
In West Virginia, insurers can set your premiums based on your health by 30 percent more or less than the standard cost, said Jessica Waltman, director of health policy research for the National Association of Health Underwriters, or NAHU, an insurance trade group.
“The rate you see online is the best-case-scenario rate,” she said.
Companies can also look at your health for the last year and refuse to cover conditions you had before applying for the policy, or pre-existing conditions, Waltman said. These conditions can go on for up to two years.
The point, of course, is to keep people from getting insurance just because they are sick, Waltman said.
But these exclusions can be somewhat arbitrary, said Trudy Lieberman, director of the Center for Consumer Health Choices, part of Consumers Union, which publishes the magazine “Consumer Reports.” A case of asthma could lead an insurer to deny all claims involving respiratory illnesses.
“These can be very minor problems, but you’re still not wanted by insurance providers,” Lieberman said. People looking for a policy should contact a broker who represents more than one company to get a good variety of choices.
The point of group- or work-based insurance is to spread the cost out over a large group of people, Waltman said. The larger the group, the less everyone pays (more or less the principle behind national health coverage). The idea is that if someone gets sick, there will be money flowing in to cover that person’s health needs.
On the other hand, when a single person or a small family gets a policy, the risk of illness shoots up while the chance of having enough cash to cover your health expenses goes down. Therefore, the policy costs more, Waltman said.
Plans employers buy — particularly those with good benefits — are more expensive than the average individual plan, but the employer fronts a lot of the cost, she said.
“It’s not that the [individual insurance] costs more. It’s just what people are used to paying out of pocket themselves,” she said. “Medical costs are still the same. Most people don’t realize what employers were paying for them.”
Until they try to pay for that policy themselves, that is. The Consolidated Omnibus Budget Reconciliation Act, or COBRA, lets people stay on a company’s insurance plan for a year and a half as long as they pay the premium themselves. Premiums can increase by several thousand dollars.
“COBRA is really a rock and a hard place,” Claxton said. “It’s usually too expensive, but it’s good coverage.”
Employees who opt for COBRA can eventually buy an individual policy without worrying about pre-existing conditions, their age or their health, Lieberman said. But you have to stay with your COBRA policy to the very end of its life. You could lose thousands before you start to save anything.
More people are being pushed into the private market as health-care costs skyrocket and employers trim back on health benefits, she said. For older employees, this can mean the inevitable ailments of age become a huge problem, Lieberman said. “The individual market is a pretty dark place.”
As the only employee of Charleston’s Shear Cut barbershop, John Ciampanella would need individual health coverage if not for his wife’s work-based insurance. (In West Virginia, a small business, for insurance purposes, means two to 50 employees, according to NAHU’s Web site.)
With his diabetes, he would be a tough sell to an insurance company.
“If you’ve got diabetes, no insurance company will take you on,” he said. “If I didn’t have [my wife’s insurance] I’d probably be up there standing in line for free shots.”
West Virginians who have been turned down for insurance because of chronic problems like diabetes can join AccessWV. Known as a “high-risk pool,” the rates and deductibles are a tad higher than the state average because mostly everyone in the plan is sick.
For instance, if the average rate is $100, the AccessWV rate would be $125, Waltman said.
On the opposite spectrum, people in good health could consider a health savings account. People going this route buy a cheap policy with a high deductible ($1,000 to $2,700 for individuals), Waltman said. Each year, the account holder can deposit money into the account up to the amount of the deductible.
The theory is that you’ll have a lot of money saved for medical care if you want it or need it. Unfortunately, it really only works if you never get sick, Lieberman said.
“They’re a gamble,” she said. “How many people can say they’ll never get sick? We don’t know.”
--------------------------------------------------------------------------------------------------------------------------------
Insurance Q&A Blog Homepage- http://insureqa.blogspot.com/
To have your questions or comments addressed send them to insureqa@aol.com
To buy a text link on Insurance Q&A Blog, Click Here- http://insureqa.blogspot.com/2006/01/buy-text-link-from-insurance-q.html
Insurance Q&A Blog Homepage- http://insureqa.blogspot.com/
To have your questions or comments addressed send them to insureqa@aol.com
To buy a text link on Insurance Q&A Blog, Click Here- http://insureqa.blogspot.com/2006/01/buy-text-link-from-insurance-q.html
posted by RonL @ 7:36 PM
0 Comments:
Post a Comment
<< Home