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

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  • Seek out comprehensive coverage. Try to find a plan that has no caps on specific coverages but especially on hospital coverage, outpatient treatment, doctor visits, drugs, and diagnostic and imaging tests. When it comes to lifetime coverage maximums, unlimited is best and $2 million should be the minimum. Ideally, there should be a single deductible for everything or, at most, one deductible for drugs and one for everything else. And the policy should pay for 100 percent of all expenses once out-of-pocket payments hit a certain amount, such as $5,000 or $10,000.
  • Consider tradeoffs carefully. If a tradeoff is necessary to lower health premiums, opt for a higher deductible and a higher out-of-pocket limit rather than fixed dollar limits on services. Policy limits on services can be exhausted quickly, leaving consumers with tens of thousands of dollars in medical bills to pay on their own. Unfortunately, consumers who can't afford either the higher premiums of a more comprehensive policy or high deductibles really have no good choices.
  • Check out the policy and company. First, look for the warning signs identified by Consumer Reports. Next, do some research. The National Association of Insurance Commissioners posts complaint information online at www.naic.org. Running a Google search on companies and policies can help, too.
  • Don't rely on the salesperson's word. Ask for an advance copy of the actual policy (though you may not always get it) and read the small print before signing up. Ask your agent or sales representative to give you written answers to your questions. That way, if the information turns out to be wrong, you can complain.

MAY 2009

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SOURCE Consumer Reports
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