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Life Health > Health Insurance > Life Insurance Strategies

Researchers Map Individual Health Coverage Gaps

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U.S. residents with individual medical insurance are somewhat less likely than members of employer-sponsored plans to get preventive care.

Researchers at the Commonwealth Fund, New York, have published figures on care access in a summary of a 2005 survey of 1,878 U.S. adults ages 18 to 65 who had been covered by private health insurance for at least a year.

The researchers found that many survey participants with private health coverage were happy with the coverage.

About 63% of the participants with individual policies rated their coverage good, very good or excellent.

Individual policyholders and members of employer-sponsored plans gave their plans similar marks for provider choice.

Only 14% of the individual policyholders reported finding that doctors did not accept their coverage, compared with 19% of the members of group plans.

The share of participants who had to contact insurers because the insurers had denied to pay claims or had failed to pay bills promptly was only 24% for individual policyholders, compared with 36% for members of group plans.

The share of participants who had done without specialist care because of insurance problems was only 8% for individual policyholders, compared with 10% for members of group plans.

But researchers also found that individual coverage is expensive and difficult for many U.S. residents to get: 22% of participants with individual coverage said they were paying $3,000 to $5,999 in annual premiums, and 32% said they were paying more than $6,000 per year.

Only 14% of the survey participants with incomes over 200% of the federal poverty level who had considered getting individual health coverage had actually bought coverage, the researchers report.

About 29% of the participants with solid incomes who had shopped for individual coverage said it was difficult to find the coverage they needed, 50% had located coverage but felt that it was too expensive, and 18% were turned down or charged a higher price for coverage because of a pre-existing medical condition, the researchers report.

Insurers rejected or offered higher than usual rates to about 21% of all survey participants who have applied for individual coverage, the researchers report.

When the researchers asked about preventive care, they found that 89% of the individual policyholders had their blood pressure checked within the past year, 75% had their cholesterol levels checked, and 67% had dental exams.

About 93% of members of group plans had had their blood pressure checked, 78% had undergone cholesterol screening, and 73% had had dental exams, the researchers report.

The researchers also found that individual policyholders were more likely than group plan members to take on credit card debt to pay for care.

America’s Health Insurance Plans, Washington, is disputing the Commonwealth Fund researchers’ assertions that applicants for individual health coverage face a high rejection rate.

A survey of AHIP member companies found that, even in states that allow individual underwriting, the individual health insurance applicant rejection rate is only slightly over 10%, AHIP says.

The Commonwealth Fund rejection rate figure may be high because the group’s survey sample includes only 137 individuals who now own individual health coverage, AHIP says.


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