Application Tips For Individual Health Insurance

In a NY Times Op-Ed piece entitled Money Won’t Buy You Health Insurance, Donna Dubinsky shares her troubles with getting individual health insurance coverage, even though she has many millions from co-founding Palm. Based on this article, here are some ways to improve your chances of getting coverage.

  1. Use an independent insurance broker. By going with an experienced broker that represents several companies instead of a sales agent employed by one single company, you have a better chance of finding a policy that best fits your needs.
  2. Apply simultaneously to many different companies. Insurers always ask “Have you ever been denied health insurance?”, and you don’t want to have to answer yes. By applying to many at the same time, you won’t have to. Besides, different insurers can also have very different underwriting criteria.
  3. Instead of applying as a family, apply to each company as individuals. One insurer might have a problem with one person in your family, and then reject everyone as a result. Dubinsky eventually found coverage for everyone in her family by going this route.
  4. Be smart when filling out your medical history. You don’t want to leave anything important out, because that can invalidate your coverage later on. The insurer will be requesting a copy of your medical records. However, on your end it’s best to provide only exactly what is required with short, direct answers.
  5. Find a way to join a group plan indirectly. The most obvious is trying to add yourself to a spouse’s group plan. Alternatively, look for potential professional groups and organizations to join in order to qualify for group health insurance plans. In some states, as long as you have a business with at least two total employees (including yourself), you qualify for a group health plan. Consider hiring an employee or even another family member part-time to qualify.

A good resource for learning about the specific health insurance rules for your state is StateHealthFacts.org. Look under “Health Insurance & Managed Care”. Finally, I absolutely agree with the final words of her article:

The new health care reform legislation is not perfect. Nothing that complex could be. But I have no doubt that the system is broken and reform is absolutely essential. If we are not going to have universal coverage but are going to rely on employer plans, then we must offer individuals, self-employed people and small businesses a place to purchase insurance at a reasonable price.

If members of Congress feel so strongly about undoing this important legislation, perhaps we should stop providing them with health insurance. Let’s credit their pay for the amount that has been paid by the taxpayers, and let them try to buy health insurance in the individual market. My bet is that they all would be denied. Health insurance reform might suddenly not seem to them like such a bad idea.

Yes!

Comments

  1. What is the best way of finding an independent insurance broker for a given area?

  2. Agree wholeheartedly with the closing paragraphs. It is absolutely insane that in the wealthiest country in the world, it is this difficult for someone to get health insurance.

    I personally feel the concept of employer-linked health insurance is ridiculous in the modern age, but if Americans insist on keeping it, we have to at least acknowlege that some people don’t fit that mould, and need an alternative.

  3. She discredits her whole piece with hyperbole like:

    “My bet is that they all would be denied. ”

    For healthy folks the individual market can be a lot cheaper than the real cost of group insurance – I’m sure relatively few congressporkies would count as healthy but quite confident a few would.

    Agree we have a big problem, but congress is much more the problem than the source of a solution.

  4. Sure, “all” is hyperbole, but how does that discredit the whole piece?

    The average age of a senator is 60. I’d bet that the majority of them would be denied coverage unless you count states that required guaranteed coverage and/or some sort of high-risk pool. Imagine being around 60, unemployed or uninsured with some prior health issues, but still years away from Medicare.

  5. @GregK,

    Don’t worry, you will not have to worry about having employer-linked health care for much longer. You will be able to go out and purchase a plan from any company that you choose. Unfortunately, it is going to cost you an arm and a leg.

    I have a good friend who works for a large health insurance company. He was telling me that they figure it will cost a family of four about $22,000 a year for a health care policy. That is a policy that basically provides catastrophic health insurance. Plan on paying for your standard doctor visits fully out of pocket. And forget about the government subsidy. They already know that they are just going to price that subsidy into your policy cost.

    Be careful what you wish for.

  6. Or we could just have medicare for all.

  7. I’m not so sure “all” is much hyperbole. My family recently went through the process of applying for an individual policy, and in some ways it was better than the NY Times article, but some ways worse.

    We are what is known as “HIPAA eligible”, which means that (this particular) insurance company had to cover us regardless of health history. In order to be HIPAA eligible, we had to meet 7 criteria, including 18 months prior coverage, not eligible for any group plans, and having exhausted our COBRA coverage. The insurance company in question had 4 coverage levels, 1 being the best.

    On my wife’s application, beyond the usual coughs and colds (which were listed), she only had one “yes” answer that later in the application required an explanation. The question was “Have you been advised of the need for future tests, procedures, surgery, or hospitalization?” Because of her family history and readings on the standard test on the higher end of the “normal” range, her eye doctor had suggested she have a new test that detected glaucoma earlier than the standard one. So we put “GDx Exam for possible glaucoma in one eye.” Not that she had glaucoma, just that she was going to have a test – and I even put what the name of the test was, so it would be understood (I thought).

    She came back rated 4 – basically a level that says “If you weren’t HIPAA eligible we wouldn’t even be talking to you.” Now, we were able to get the eye doctor to send the insurance company a letter that explained the situation and she got dropped back down, but still, isn’t that crazy?

    Long story short (too late), I wouldn’t be a bit surprised either if all of Congress (well, not that Cosmo coverboy Scott Brown) were turned down.

    Lots more fun stuff from our experience, but this comment is too long already.

  8. This article only adds to my conviction that we need a single payer health care system. My employer recently failed to pay the monthly premiums for our group for 2 months in a row. We received letters from the insurance company stating that our coverage had been terminated. This was all solely due to the negligence of the employer, not to any lack of funds. Eventually, after much anxiety, the situation was resolved, but this sort of thing happens to people all the time and would not happen under a single payer system. I am actually pleased to see that even wealthy people are beginning to have difficulties with our current system, because only when the upper class is inconvenienced will we see any change.

  9. vijaianand says:

    I totally agree with the article. I have individual insurance for almost 5 years now. I switch companies every time they hike my price. Once time I had a policy in 3 different insurance providers to cover my family. One for myself, one for my wife to cover her maternity and one for my kid. It was insane to keep up with the copays but you gotta to do what you gotta to do save some money right.

    Many people forget about Maternity cover when comes to individual insurance. You can count the number of providers who cover maternity for individuals and self employed. I had trouble finding one when we want to get pregnant 2 years ago. I finally found one and paid good amount of money to get my wife insurance. Even after that, I ended up paying $5k deductible and they try to get more from me. I just completed the appeal process with the insurance company and they finally agreed to pay some money for a provider.

    We need coverage for individuals and self employed with flexibiilty to choose differnt coverage which won’t cost too much. I don’t thats going to happen ever. May be in 2014 if the law is still alive and they allow coop pools and we are allowed to buy from it. Let see..

  10. @ Greg,

    “…wealthiest country in the world”? What country is that? We are the most indebted country in the world.

    And the last thing we can afford is a bloated government run health care system. I know…it’s a great idea ’cause the govt. does everything so much more efficiently than the private sector, right?

    Of course the medical insurance system is broken. But let’s look at the root causes of the problem and fix those issues, not add another layer of bureaucratic bs over and above all the other problems we already have.

    Thinking that this administration is going to fix our problems by shoving this deranged plan down our throats against the will of most Americans will be as effective and good for our country as letting the congressmen and the assorted unions decide that they should be in charge of choosing their own benefits, wages, and health care options, while not paying anything toward the cost themselves.

    It is simply unsustainable…and we are about to figure that out!

  11. The biggest problem with health care in this country is not the insurance companies, and not employers, and not politicians. It is us!

    We, as a country, are too short sighted and too polarized to engage in a real, substantative, and civil debate over health care. There is so much politics, and so much rhetoric spewed by all parties that we can’t make any real choices.

    The reality is that we can’t have universal coverage of everything at little or no cost. You can have gold plated insurance that covers everything with no conditions or limits. You can have universal insurance where everybody is covered. You can have coverage that is cheap. However, you can’t have all three at the same time. At most, you can have two out of the three.

    We need to have an honest conversation to understand which two we want to choose in this country. Do we want to cover everybody? Do we want low taxes? Do we want coverage without limits? Unfortunately, we want it all. Our politicians then have a choice. They can either tell us to truth and say that we have to give up something. However, that is a recipe for getting booted out by the electorate. Or they can have the courage to be honest and tell us something we don’t want to hear.

    Everyone says that our system is broken, but if a politicians came and said that to fix it, you are going to have to give up something, would you vote for that person? Honestly? Doubtful.

    If I had to blame one politician, though, it would be Sarah Palin. She totally derailed the entire health care debate with her “death panel” scare tactics. She made up some stuff about how health care reform is going to lead to a governement panel to tell you whether you can live or not. That is total hogwash, but yet WE believed it because we didn’t want to discuss the real issues of dimensions of the health care debate.

  12. OK, PeterA. So in your forecast,
    health insurance is totally out of reach for
    anyone. (btw, it’ was going that way even WITHOUT ObamaCare)
    Don’t you think maybe the market will come up with a way around
    the insurance companies? They and the lawyers are some of the
    biggest obstacles to affordable health care out there. (Yes, and the
    politicians, sigh.) Yeah, I wish for ObamaCare, because for anyone with
    a pre-existing condition is ALREADY in or near your ‘horrible
    example’.

  13. Bryce Shashinka says:

    I work for a mid size telecommunications company with approx 14,500 employees and the company pays ~$12,500. for two people while we pay about $500 per year. I would hate to know how much it would be if i didn’t have the group rate.

    I too agree that any elected official who votes against health care reform should have their coverage revoked and have to purchase it entirely on there own.

  14. Great article and tips! I like the part about joining a group plan indirectly, and I love it. There are many organizations/business groups that will offer some type of heatlh insurance, and this is a great “back door” way to get coverage. Keep up the great posts!

  15. All this talk about insurance and not one mention of the driver of insurance costs. THE COST OF CARE ITSELF.

    You want to bring down costs? Do something to bring down the cost of care. Why did I have to pay $6.00 for 1 dose of Ibuprofen for my son in the emergency room?

    Also, some people need to realize that “insurance” is supposed to cover events that MIGHT happen, not stuff that ALREADY happened. Covering something that has already happened to you is not insurance. That’s called a free ride.

  16. And the idea that we are the wealthiest nation in the world is a joke. Since when did being $14 TRILLION in debt equate to being wealthy? Give me a break.

  17. The article is discredited by the politically charged paragraphs at the end. They completely take the focus off what could be good advice in the body of the article. Just look at the comments here. All about politics.

  18. Warren,
    I’m afraid we won’t get the politics out of money matters until we get the money out of politics. In other words, never.

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