Making heads or tails of health care plan options

Health insurance is confusing – regardless of whether your employer provides your insurance, you qualify for Medicare or Medicaid, or if you are footing the bill yourself for private insurance.

If you’re in the market to buy insurance on your own, you may worry you might be turned down due to a pre-existing medical condition or you will be charged a higher rate once the insurer reviews your application. And even if the insurer approves your application, you may have questions about what’s covered under your plan and how much you’ll need to pay for out of pocket if you have a major health problem.

A free health insurance resource company for consumers, HealthPocket, recently reviewed data on individual and family health plans offered to Americans throughout the country. It published its findings in a series of “InfoStat” analyses of issues that consumers should investigate when applying for and using their health coverage. Also, because many health plans will change due to implementation of “Obamacare” standards in 2014, it will be important for consumers to watch how their existing policies might change in the coming months.

Highlights of the HealthPocket InfoStats:

* The average individual health insurer rejects 22 percent of the applications submitted to it.  This means many people with health issues may have a hard time obtaining coverage. Also, health plans on average end up charging 18 percent of applicants a rate higher than the originally quoted premium price. The ability of health plans to reject or price policies based on the applicant’s health status will be eliminated in 2014.

* Thirty-six percent of plans require consumers to spend more out of their own pockets for health care than the maximum allowed next year in Obamacare plans.

* On average, health plans cover only 76 percent of the key benefits that will be incorporated in health plans next year. Most of the shortcomings are in maternity, mental health and certain children’s benefits, such as dental and vision.

Considering these findings, you should carefully review the following while making decisions about your health insurance:

* Percent of applicants turned down for coverage by a health plan or charged a higher premium than the quoted price. For example, a consumer may want to avoid applying for health insurance at a plan that frequently rejects applicants since other health insurers often ask if you have ever been denied health insurance when considering an application. Rates of rejections and premium increases can be found in the “Plan Details” of every plan in the individual coverage section of the HealthPocket website.

* Deductible amount. This figure tells you how much you pay out of pocket before your coverage kicks in and starts to pay for your care. Some plans offer full coverage for preventive care treatments even if the deductible hasn’t been met, so be sure to review this information before applying.

* Out-of-pocket limit. Many plans will list a dollar figure for total out-of-pocket spending. These plans usually have partial coverage of expenses once the deductible has been met. For example, the plan will pay 80 percent of costs for a doctor’s visit, requiring the patient to pay 20 percent. When the patient reaches the out-of-pocket dollar limit after paying the deductible and patient-responsible costs of medical treatments, the plan will then pay 100 percent of the costs for covered medical services.

* Covered services. Plans vary in what types of medical care they will pay for. For example, you may want to look at coverage for maternity expenses and well as mental health coverage.

Doing your research prior to applying and buying health insurance is very important to make sure you get the type of coverage you actually need, and don’t overpay for it. HealthPocket has objective details about all health care coverage plans available by zip code on its website, allowing people to compare health insurance options side by side. The site provides information about cost and quality that helps people match a health plan to their budget and needs, and doesn’t charge consumers for using the site. Visit to learn more about your health insurance options before making this very important purchase.

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