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Hazardous Health Plans: Consumer Reports Investigation Finds Serious Gaps in Individual Health Insurance Policies
Date:4/6/2009

er $200,000.

Findings Show How Difficult it is for Consumers to Get Good Health Policies on Their Own

For its investigation, Consumer Reports hired a national expert to help evaluate a range of health plan policies and interviewed consumers who bought those policies, as well as insurance experts and regulators to learn more. Among the findings from the investigation:

  • Health insurance policies with gaping holes are offered by all kinds of insurers -- large and small. Most states do not task regulators with evaluating overall coverage.
  • Disclosure requirements about coverage gaps are weak or nonexistent, so it's difficult for consumers to figure out in advance what a policy does or doesn't cover.
  • In many states, people of modest means may have no good options for individual coverage. Plans with affordable premiums can leave them with crushing medical debt if they fall seriously ill, and plans with adequate coverage may have huge premiums.

"A good plan should pay for necessary care without leaving you with lots of debt," Metcalf says. "Decent insurance covers more than just routine care -- it's supposed to protect you in case of a catastrophically expensive illness. But many individual plans do nowhere near this job."

Consumer Reports identifies seven clues that a health plan might be junk:

  • Limited benefits. Do everything in your power to avoid buying a product labeled "limited benefit" or "not major medical" insurance -- a sure warning sign of inadequate coverage.
  • Low overall coverage limits. Health care is costly. Policies with coverage limits of $25,000 or even $100,000 are not adequate.
  • "Affordable" premiums. If premiums are very low, chances are good that the policy doesn't cover very much.
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SOURCE Consumer Reports
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