Individuals in Search of Health Insurance

If you do not have health coverage, either through the government or through a private employer, you are left to find one for yourself. It is a daunting task, one that has left more than 40 million Americans with no health insurance coverage. If this is the case for you and you are seeking health insurance, you may be faced with a number of challenges:

• Insurance companies are reluctant to insure most people with preexisting medical conditions. If they do offer coverage, the premiums are extremely high.
• Many benefits such as maternity care, mental health, and prescription drugs are usually excluded.
• The application process can be long and very intrusive.

Some states have created laws to help control these practices. They include:

• Preventing insurance companies from eliminating coverage for preexisting medical conditions. These laws do not, however, force the insurance companies to accept an applicant, only that if the applicant is accepted then their preexisting condition must be covered. Insurance companies are then free not to accept an individual with a preexisting condition, or to accept one and charge much higher premiums.
• Creating high-risk pools to provide coverage for individuals who have been turned down because of their conditions. These policies are usually more expensive but do provide coverage that would otherwise not be available. An individual with
AIDS, for example, would have a hard time getting regular insurance. A high-risk pool insurance would provide coverage for that individual.
• Creating laws that require health insurance companies to provide health insurance at premiums that are set on a market by market basis. This means that the state is broken up into different markets, and for each market the company creates a rate without regard to age, sex, or health status. Every individual in that market gets the same rate and benefits. For healthier individuals, these programs tend to be more expensive than regular plans.

If you are looking to buy health insurance, contact your state’s department of insurance. Any company that sells health insurance in a state has to be licensed in that state and must comply with the insurance laws of that state regarding what it can and cannot do. Appendix A lists the phone numbers of the insurance departments of the different states.