Insured at What Price

Until this month, I was one of the 45.6 million Americans—that’s 15.9 percent—without health insurance. For those without an employer-based insurance plan, it can be difficult to get affordable (if any) coverage if you’ve had more serious health problems than a bruise.

When I left my job, I figured that as a young, healthy nonsmoker, it’d be easy to get affordable coverage. Then, I was denied. My crimes? Antidepressants (years prior) and fainting once when I had the flu. When I finally found a bare-bones plan that I could handle ($125 per month), the process left me soured. What about those who have serious health problems, or who can’t afford $125 a month? Why is it so hard to get insured in America?

Not Perfect? No Coverage

Whereas an employer with a group insurance plan can’t deny you coverage, companies selling individual insurance usually can, thanks to medical underwriting—which is basically medical background checks. It allows insurance companies to pick and choose who they cover, and at what price, based on perceived “risk,” which is code for cost. Medical underwriting is only illegal in New York, New Jersey, Maine, Massachusetts, and Vermont.

There’s a misconception that this only affects crack addicts and cancer patients, but that’s not the case. Routinely denied are those with asthma, allergies, diabetes, or migraines. You can be denied for things in your past, such as an abnormal pap smear, infertility treatments, or an MRI (even if it showed you were healthy). Coverage offered despite a “pre-existing condition” is often more expensive, and may actually exclude coverage for the condition in question.

Pay Up

Pre-existing condition or no, health insurance isn’t cheap. And since it’s tied to employment for most Americans, many are out of a job and out of insurance at the same time. Many unemployed people find it difficult to justify an added monthly expense—not to mention that $100 a month won’t even get you decent health coverage. Plans with low premiums generally have a high deductible and/or don’t include things like dental and maternity services. Sometimes, they don’t even include prescriptions. An HMO plan on par with the coverage at my old job was quoted at $600 a month. For those with chronic health problems, coverage for prescriptions and specialists can be vital. Deductibles have to be affordable, because you will likely have to pay them.