"The healthy individual out there buying insurance does not have that much trouble," says Sandy Praeger, president of the National Association of Insurance Commissioners and insurance commissioner for the state of Kansas. But for people with health issues or pre-existing conditions, "it can be tough, if not impossible to find coverage in the individual market."
And then there's shopping for policies. For people who've never had to do it themselves, "there is the perception that you make a call or two and you've got it," says Jerry Flanagan, health care policy director for Consumer Watchdog, an advocacy group. "You have to do a lot of research, know what you're getting and buy it before you cancel your (current) coverage."
"The individual market is a very difficult place for consumers to find affordable care with good coverage," he says.
If you're purchasing your own health coverage, there are three big issues.
With group policies, insurance companies have to cover anyone the company hires. But with individual policies, carriers have the freedom to cherry-pick customers.
3 issues for private health insurance
- Can you get coverage?
- Can you afford the premiums on the policy?
- Does it cover what you need covered?
"In most states, companies can charge you more or deny coverage for pre-existing conditions," says Flanagan. But in a handful of states, they can't. Get the details from your state insurance department, so that you know what to expect.
And sometimes the exclusions or limitations don't even concern a current condition. If you're a woman of child-bearing age, you could face a large deductible on anything related to maternity care.
"Most individual policies will have a huge deductible when it comes to maternity," says Scott Leavitt, national president of the National Association of Health Underwriters, and president of Scott Leavitt Insurance & Financial Services in Boise, Idaho. If the cost of the average pregnancy is $10,000, the deductible might be half that, he says.
In the face of less-than-picture-perfect health or exclusions, "I think what a lot of people are opting for are scaled-back plans," says Praeger. Coverage may not cover certain areas, like mental health services, maternity care or drugs. And it may limit the number of times you can see a doctor or have certain screenings.
Carriers can drop coverageConsumers buying their own coverage face another challenge that didn't exist when they were under the group umbrella -- being dropped.
Under a group policy, the insurance carrier has to cover everyone in the group. It can raise the rates on the group, but it can't just drop someone. With individual insurance, the carrier can do both.