 1. Can I be turned down for health insurance? 2. Will I get the same kind of coverage under an individual insurance policy as I would if I were covered by an employer? 3. Do I have to be honest about my pre-existing medical conditions? 4. I can’t afford individual health insurance coverage. Are there any other options? 5. I’m young and healthy. Why do I need health insurance? 6. Why can’t I buy health insurance later, when I really need it? 7. I’m still covered on my parents’ insurance policy, right? 8. It can’t really cost that much if I get sick…can it? 1. Can I be turned down for health insurance? In all but six states, companies that sell individual health insurance are free to turn you down because of your health status and other factors. When applying for an individual policy, you will be asked questions about health conditions you have now or had in the past. Depending on your health status and prior medical history, insurers might refuse to sell you coverage, offer to sell you a policy that has special limitations on what it covers, or offer you a policy with higher premiums. If you live in Idaho, Maine, Massachusetts, New Jersey, New York, and Vermont, you cannot be refused health insurance coverage because of your health status. Thirty-two states operate high-risk pools for individuals who are denied insurance on the basis of poor health status. Eligibility rules vary, but many states require enrollees to have been denied coverage from insurance carriers or to have certain high-costs conditions. For a list of state high-risk pools and contact information please visit www.selfemployedcountry.org/riskpools/states.html In all states, insurance companies cannot cancel your policy because you get sick. However, in most states, the insurer can increase your premiums in the event of illness or injury. Return to top. 2. Will I get the same kind of coverage under an individual insurance policy as I would if I were covered by an employer? Not necessarily. Individual health insurance is very different than group, or employer-based, health insurance. Because the laws governing these policies are different, the benefits and services are often different, too—and often less comprehensive. For example, some benefits that may be considered standard in a group policy, like maternity coverage or substance-abuse treatment, may not be included in an individual plan. Or, you might have to pay extra to purchase optional coverage for those benefits. Return to top. 3. Do I have to be honest about my pre-existing medical conditions? In most states, when you apply for individual health insurance coverage, you are asked to fill out a brief medical questionnaire to provide health information about yourself and any family members to be covered. Insurance companies use the medical information provided to determine whether to offer coverage and at what price. Sometimes they will also request additional information from your physician. It’s important to provide this information; without it, insurers may deny you coverage or charge you more. It’s critical to be honest. If your insurance company issues you coverage, and then determines that you failed to mention a serious pre-existing condition, you’ll be required to repay the costs of any coverage you received for that condition, and your insurance may be cancelled. Return to top. 4. I can’t afford individual health insurance coverage. Are there any other options? Here are some additional options, although availability may be limited:
5. I’m young and healthy. Why do I need health insurance? You need health insurance because it’s the smart thing to do. Life is full of risks, many of them completely unforeseeable. You could get the flu, sustain a sports injury, or be involved in a car accident. Health insurance not only can get you faster and better health care, but the out-of-pocket costs to you will be less with insurance than without. There’s also preventative care. Health insurance allows you to get regular checkups and, in many cases, early detection and treatment for serious conditions. Plus, it’s nice to have a doctor you can call with questions or concerns. Return to top. 6. Why can’t I buy health insurance later, when I really need it? You’ll spend much less money on health insurance if you buy it when you’re healthy than if you wait until you get sick. For example, a healthy 22-year old man living in Nashville would spend on average about $70 a month for health insurance. Compare that to on average about $240 a month if he had diabetes, depression, hypertension, obesity or severe asthma. Plus, many insurance companies charge higher premiums if you have a pre-existing condition—that is, if you’re already ill or injured when you apply for health insurance. They might refuse to cover costs for that particular illness, for up to a year. Or, they might refuse to insure you at all. The bottom line: Insurance is a thing you need when you don’t need it. Return to top. 7. I’m still covered on my parents’ insurance policy, right? It depends. You’re probably covered on your parents’ health insurance policy if you’re a full-time student in high school or college. In some states, you might be covered until you’re 25 if you’re unmarried and living at home. However, if you’re out of school and out of the family household, you’re probably responsible for your own health insurance. Return to top. 8. It can’t really cost that much if I get sick…can it? Yes, it can—and that’s not the only risk you run. Without health insurance, some doctors and hospitals can refuse to treat you. If they do consent to treatment, it can cost you an arm and a leg (no fooling). Are you a snowboarder or skateboarder? The average cost to X-ray, set, and cast a broken leg is over $10,000. Still got those tonsils? A routine tonsillectomy for a healthy adult is more than $5,000. Rugby, soccer, football, tennis? The average cost to repair a knee injury is almost $12,000. And those estimates don’t include the costs of your hospital stay—around $1,500 per day. Without health insurance, these expenses are billed directly to you. Return to top. |
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