Ask Wendell: How to find health insurance

Wendell Potter answers questions from readers about health care issues

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A doctor and patient in Pittsburgh.

Keith Srakocic/AP

Earlier this month I wrote that the Center for Public Integrity would launch “Ask Wendell” to help people who are at wits end trying to resolve a problem with their health insurer or who are trying to find decent affordable coverage but don’t know where to find it.

Your emails and tweets starting flowing in immediately. As I suspected, there will be no shortage of problems to tackle in the weeks and months ahead. We in the United States have one of the most complicated, confounding and unfair health care systems on the planet. But I hope to be of at least a little help to the people who write. So here goes.


Dear Wendell,

Our COBRA will run out next June and I've started to look for something cheaper. My 24-year-old daughter and I both have some made-up preexisting conditions, according to a few insurance companies that we've applied to, even though my doctor says that mine is not even a medical problem.

This has prevented us from getting individual plans. My husband and I are self-employed and my daughter's employer doesn't provide insurance. I don't really want to go without insurance for six months in order to get on Pennsylvania’s high-risk plan so I have been looking into an indemnity plan. I know it's not major medical, but (the company has) a plan called "Hospital Confinement and Surgical Fixed Indemnity Plan". The premium is lower but I'm not entirely sold on what I was told about it. Is this an OK avenue to pursue?

Audrey


 

Dear Audrey,

Your situation illustrates all too well why Americans who would like to go into business for themselves or to start a new business are reluctant to do so, especially if they’ve ever been sick in the past. That’s what job lock is all about. Millions of our best and brightest are locked into corporate jobs because their employers offer health care benefits not available at an affordable price to small businesses and individuals.

That should change in 2014 when the state exchanges are up and running, as required under the health care reform law enacted last year. As you probably know, the law requires every state to have an exchange—an online marketplace where people can go to shop and compare health plans and buy coverage if it is not available to them through the workplace. If your state hasn’t demonstrated by 2013 that it will have its exchange up and running by Jan. 1, 2014, the federal government will step in and operate it.

COBRA coverage—available to people who lose their jobs and, along with them, their employer-subsidized coverage—is extremely expensive, as you have found out. Federal law mandates that COBRA coverage is available to you, but because your former employer does not have to subsidize the premiums, you’re on your own. As a result, only a small fraction of the people eligible for COBRA coverage takes advantage of it. And, of course, it runs out after several months.

The reform law also will eventually prohibit insurers from refusing to sell coverage to anyone because of a preexisting condition. The prohibition already applies to children. It will apply to adults in 2014.

But because 2014 is still a long way off, your options are limited, unfortunately, as you have found out.

The plan you are considering is a limited benefit plan. If the reform act is implemented as Congress intended, limited benefit plans, which are often very inadequate and often little more than junk insurance, will be phased out.

Before you decide, be sure you see in writing exactly what benefits are covered and what is excluded. Also be sure you know what your total costs will be, should you or a family member get sick or injured.

Thousands of Americans lose their homes and file for bankruptcy because of medical debt, and many of those people have what they thought was adequate health insurance. They found out too late that it was not adequate—or they gambled too much that they would not get seriously sick or injured. The United States, by the way, is the only country in the developed world where people can go bankrupt and lose their homes because of medical debt.

Before making a final decision, I suggest you go to www.healthcare.gov. That’s the new Web site created by the Department of Health and Human Services following the enactment of the reform law.

This site has a wealth of information for anyone looking for coverage or who has questions about health care reform. When you visit the site, click on the tab, “Find Insurance Option.” Then fill out the demographic information and hit “submit.”

You will see a listing of the options available to you in your state and with at least some information that should help you make a more informed choice. You might find that you can qualify for better coverage than you thought.

But if you decide to go with the limited benefit plan, I suggest you call your state’s insurance department and ask questions, such as how long the company has been operating in your state, how many complaints have been filed against them and how many enrollees they have in your state.

In 2014, if all goes as planned, you will have better options, and you’ll be able to compare plans with each other in ways never before possible.

Good luck!

Have a health care question for Wendell? Email him at wpotter[at]iwatchnews[dot]org or post your queries in the comments below.