One family's quest for health insurance coverage -- and questions to ask on policy proposals relying on the individual market

Published on
April 25, 2012

My colleague Celeste Monforton has written a terrific post at The Pump Handle about the experience she and her husband had applying for health insurance through the individual market. This, she points out, is the free market that many lawmakers tout as the solution to our country's healthcare woes – but she and her husband, both of whom are well educated and in good health, still found the process challenging.

An insurer did offer Celeste and Jim a plan that met their needs at a premium they could afford – which makes them more fortunate than most people who try to buy health insurance coverage through the individual market, and than the 26% of their fellow Texas residents who are uninsured. There are several specific ways in which Celeste and Jim are fortunate:

  • Time: Jim was able to spend many hours researching insurance plan options, and most of an entire Saturday and Sunday filling out applications online. (If they'd filled out the applications on paper, it would've cost more.) His research also yielded an important tip: apply to multiple insurers simultaneously, because if you apply to one and get rejected, you'll have to disclose that on your next application.
  • Money: They could afford to pre-pay the premiums required for application for multiple insurers simultaneously, in order to avoid the possibility of getting turned down by one insurer and then having to disclose that in their next application.
  • Records: They had few enough interactions with the healthcare system over the past five years, and good enough information about them, to be able to respond to the very detailed application questions about their conditions and treatments.
  • Health History: The fact that Celeste and Jim were approved fairly quickly for their top-choice plan probably has a lot to do with the fact that they're both relatively healthy, with only occasional bouts of things like poison-ivy reactions. Until 2014, insurers can still deny coverage to adults based on health status – and if that portion of the Affordable Care Act is struck down by the Supreme Court or repealed by Congress, such denials will continue. (For more on insurance-related provisions of the ACA, visit the Kaiser Family Foundation's Implementation Timeline and customize by the "Insurance" topic.)

And even after they carefully followed all the application instructions, they ended up getting a dire-sounding notice from a collections agency, because an insurer with which they'd canceled their coverage application sent them a refund check that was $39.57 higher than the advance premium they'd paid.

Celeste notes that this experience is relevant when considering the merits of proposals to replace Medicare coverage with vouchers for seniors:

Throughout our on-line application process (which doesn't by-the-way offer enough options to save your work,) we remarked constantly how much more time consuming the process would be if either of us had any serious health challenges. We thought about our four elderly parents who are in ill health, and proposals to eventually give seniors a voucher to help the purchase insurance. Forget about the voucher for now, how in the world would your average senior pull together 10 years of their healthcare information in the level of detail expected by insurers' for these applications? We also thought about parents with seriously ill children trying to fill out these detailed applications, or parents with just several children who experience the average number of aches, breaks and illnesses.

Celeste has a question for lawmakers:

It really makes me wonder about those Members of Congress (mostly Republicans) who insist our nation's healthcare woes would be fixed if more people just had private health insurance. How many of these Members have applied recently for non-employer based, private health insurance?

For journalists covering such healthcare policy proposals (like Congressman Paul Ryan's plan to replace Medicare with vouchers for those of us currently under age 55) or the Supreme Court decision on the Affordable Care Act this summer, it's relevant to talk to people with experience applying for health insurance in the individual market. Celeste's experience suggests some questions to ask:

  • How easy or difficult was it to find a plan that would suit your needs?
  • Did you apply to multiple plans simultaneously? Why or why not?
  • Did you have all of the information needed to complete the application(s)?
  • Did you encounter any barriers to completing an application?
  • How much time did the process take?
  • Did you get offered the coverage you applied for? If so, was the premium what you expected it to be?
  • Do you have any advice for others in situations like your own?

If anyone can find a Member of Congress who's recently applied for health insurance coverage on the individual market and who'll answer these questions, I'll be very impressed! We could also ask Members suggesting Medicare vouchers or ACA repeal if they can recall or quickly produce their families' entire health histories for the past five years.

Read Celeste's full post at The Pump Handle.