If you’re unemployed, looking for a job can be grueling. Finding affordable health insurance isn’t much easier.
People who don’t have employer-provided coverage have options, ranging from individual insurance policies to government-funded programs. But information about these plans and programs is often fragmented and confusing.
Now, the Department of Health and Human Services has launched a website, HealthCare.gov, that’s designed to help consumers identify sources of public and private coverage.
If you’re looking for an individual insurance policy, you’ll be asked to provide your age, your state of residence, and whether you have a medical condition. Once you’ve done that, you’ll get a list of plans available in your area. You’ll get a summary of each plan’s benefits, and you’ll be able to find out whether your doctor is in the plan’s network. What you won’t get are prices: The site won’t provide premium estimates until October. In the meantime, you’ll have to contact the providers directly.
Even with those limitations, the site provides useful information for consumers, says Jennifer Tolbert, policy analyst for the Kaiser Family Foundation. Online health insurance sites provide premium quotes for individual insurance plans, but they usually don’t provide information about government-run programs for you or your children, she says.
If you’re young and healthy, you can probably find an affordable insurance policy without help from the government. But consumers with chronic medical problems have a much tougher time finding coverage. Premiums for individual insurance policies are extremely high for people with pre-existing medical conditions, and some insurers won’t cover them at all.
Starting in 2014, insurers will no longer be allowed to deny coverage to people with medical problems. In the interim, the government has set aside $5 billion to set up high-risk pools for people who have been locked out of the insurance market. If you fall into this category, HealthCare.gov is the gateway to information about these plans, which will be administered by the states.
Premiums vary significantly among states. For example, premiums for New York’s high-risk pool range from $400 to $600, according to the website. Residents of Pennsylvania will pay $283 a month, with a $1,000 deductible for in-network coverage.
The difference reflects the way premiums are calculated, Tolbert says. Premiums for state high-risk pools are tied to the standard individual insurance rate for a healthy person in that state. Those rates vary, based on the cost of health care in different parts of the country.
Within a particular state, rates may differ depending on the age of the individual. States are prohibited from charging higher premiums based on medical conditions, but the law allows them to charge older applicants up to four times more than they charge younger people, Tolbert says.
To qualify for the high-risk pools, you must have been uninsured for at least six months. You must also prove that you’ve been turned down for insurance because of a pre-existing condition. To do that, you’ll need a denial letter from a private insurance company. You may also be eligible if you were offered coverage but denied certain benefits because of a medical condition. If you live in one of the six states that require insurers to offer insurance to everyone, you’ll need to show that the plan provided was unaffordable.
Some health care analysts have questioned whether the $5 billion allocated for the high-risk pools will be enough to cover all of the people who will apply. It’s too soon to determine whether the program will come up short, says Ron Pollack, executive director of Families USA. But in any event, people who have been uninsured for at least six months and have a pre-existing condition should apply as soon as possible, he says.
Twenty-one states have opted to allow the Department of Health and Human Services to run their high-risk pools. The remaining states have decided to run the pools themselves. If your state’s plan is being managed by HHS, you can download an application now. Individuals who apply by July 15 will be eligible for coverage by Aug. 1.
For state-run high-risk pools, application and coverage dates vary. You can find more information at HealthCare.gov.