Shopping for a health insurance plan
The five states that have outlawed individual medical underwriting instead require community rating, a system in which every consumer is eligible for coverage regardless of health condition, and everyone pays the same premium for the same policy.
Malasnik agrees that underwriting has a huge influence on the availability of health insurance. "When people are going online ... to these automated Web sites where you put in information and you get a bunch of rates, somebody with high blood pressure and high cholesterol, for example, might think they are healthy," he says. "But six out of 10 insurance companies are going to deny them once they see that combination. It's very important that people understand what companies will accept which health conditions."
A number of Web-based brokerages sell health insurance online, including InsureMe, a Bankrate company.
Get the full explanation of benefits
When you've narrowed your choice down to a few plans, get your hands on the official explanation of benefits, or EOB, for each of them. It may not be easy, since according to Bangit the general practice among insurance companies is to send this document only after the consumer has enrolled in a plan.
"But don't take no for an answer," Bangit says. "Just insist that they provide it, and if they don't, you move on."
In Bangit's view, simply reading the brochure or the executive summary is not sufficient. Only the EOB will spell out exactly which of your health care expenses count toward your deductible and maximum out-of-pocket liability.
"In most of the plans we looked at in California, for example, the prescription co-pays do not count toward the out-of-pocket maximum," she says.
Other caveats: Look out for benefit limits, exclusions and coverage caps. And don't assume a procedure is covered just because it's not listed in the "excluded benefits" section of the plan.
Use some assessment tools
Finally, check out some additional helpful resources. To sort the wheat from the chaff among health plans, it's a good idea to talk to several independent agents that specialize in health insurance. Some helpful information is available on the Web.
At the Health Policy Institute, you can access the "Consumer's Guide for Getting and Keeping Health Insurance." The HPI has produced a guide for each state and the District of Columbia.
On the Web site of the National Association of Insurance Commissioners, you can link to the page for your state insurance department, which lists licensed insurance carriers.
Healthcarecoach.com, a project of the nonprofit National Health Law Program, educates consumers about their legal rights and provides a wealth of information about health plan options.
The Health Insurance Association of America also recommends checking the financial soundness of any insurer you are considering through a rating firm such as A.M. Best, Standard & Poor's or Moody's.