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

To check how much a comprehensive plan might cost, Consumer Reports recommends visiting ehealthinsurance.com and examining the more expensive plans available in one's state.
  • No coverage for important medical care. If the policy doesn't describe coverage for a specific medical service, such as outpatient chemotherapy, assume that it's not covered.
  • Ceilings on categories of care. A $900-a-day maximum benefit for hospital expenses doesn't pay much of a $45,000 bill for heart bypass surgery. Consumer Reports advises consumers to make sure that their plan covers hospital and outpatient medical treatment, doctor visits, drugs, and diagnostic and imaging tests without a dollar limit.
  • Limitless out-of-pocket costs. Consumers should avoid policies that fail to specify a maximum amount they'll have to pay before the insurer begins covering 100 percent of expenses. Some policies, for example, don't count co-payments for doctor visits or prescription drugs toward the maximum.
  • Random gotchas. The AARP policy that the Clausens bought began covering hospital care on the second day. That may seem benign, except that the first day is almost always the most expensive, because it usually includes charges for surgery and emergency-room diagnostic tests and treatments.

  • Why all the confusion about health insurance? Consumer Reports says one reason is that health insurance is regulated by the states, not by the federal government. Most states (Massachusetts and New York are prominent exceptions) do not have a standard definition of what constitutes health insurance.

    How Consumers Can Protect Themselves

    A good plan will cover legitimate health care without burdening consumers with oversized debt. Consumer Reports offers the following advice for choosing a heal
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    SOURCE Consumer Reports
    Copyright©2009 PR Newswire.
    All rights reserved

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