Individual Health Insurance Costs

By DINA ELBOGHDADY



The Washington Post





If you have a job or a job offer, but no health insurance to go with it, you are not alone.



About 74 percent of the nation's 45 million uninsured people worked in 2003, the most recent available U.S. Census data show. Most of them worked full-time, year-round in small businesses. Others worked part-time or in seasonal jobs.



Whatever their situation, the majority were not eligible for employer-sponsored health plans, which typically are the most comprehensive and least expensive because employers pick up a lot of the premium payments.



But consumers do have other places to turn for coverage.



Choices include shopping for an individual health plan, signing up for the relatively new, tax-advantaged "health savings account," or enrolling in high-risk pools created by some states for people who are rejected for coverage elsewhere.



If you want to look into individual insurance coverage, start by asking your home or car insurance agent to recommend a health insurance agent.



You also can search for agents on the Internet or work with an online broker, such as eHealthInsurance.com or Insure.com. Or you could call the company directly.



But be aware that individual plans are pricey and less generous than most employer-based plans. Prescription drug coverage likely will be limited, and maternity benefits will be tough to find.



These plans cost more because they are not subsidized by employers. In addition, buying for one person is much less efficient than buying for a group, as employers do.



Consumers who buy on their own get roughly 60 to 65 cents worth of coverage for every $1 they pay in premiums, compared with 85 cents for those with job-based plans, said Gary Claxton, a vice president at the Kaiser Family Foundation.



The rest goes toward administrative overhead.



Because most individual insurance is medically underwritten, insurers have substantial discretion to decide what they will cover and for how much, Claxton said.



Underwriting is the process by which insurers assess an applicant's health before granting coverage.



"But once they take you, they are not supposed to change your rates because you get sicker or develop an illness," Claxton said.



If all else fails, see whether your state offers a "high-risk pool" for people who have been rejected for medical reasons by individual plans and do not have access to group coverage or federally sponsored health insurance, said Karen Pollitz, project director at Georgetown University Health Policy Institute.



Karen Ignagni, president of America's Health Insurance Plans, an association that represents insurance companies, also suggests looking into health savings accounts, approved by Congress as part of the 2003 Medicare law.



Although the search for insurance might be time consuming and frustrating, many experts say it is worth the effort. The Institute of Medicine reports that 18,000 uninsured Americans die each year because they get less care than they need and get it later than they need it.