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Health Insurance: A Look Back -- And Ahead

Ten people made their health plan choices last year. See how those selections panned out.

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By Alicia Ault
Special to The Washington Post
Tuesday, October 16, 2007

Barbra Lancelot has a master's in education and a long career working with special-needs children. Until recently, she also had a good health insurance plan and prescription drug coverage, provided by her employer. But late last year, the 58-year-old College Park resident lost her job. Coverage was extended to her under COBRA, the law that guarantees temporary continuance of employer-provided insurance but requires the worker to pay the full premium.

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It soon became a choice between paying rent or shelling out $350 a month for insurance premiums and another $800 a month for the eight prescription medications Lancelot takes for a variety of chronic conditions, including depression and fibromyalgia.

She chose to keep a roof over her head.

And as Lancelot quickly found, there aren't many options available for people like her who make a small income and are not fully disabled.

Estimates vary widely, but according to the University of Michigan, about 66 million people were uninsured for some part of 2004.

A more recent study by the Washington-based advocacy group Families USA estimates that roughly one in three people in this region were uninsured at some point last year, and did not qualify for Medicare, the federal health insurance program for people older than 65 and those who are permanently disabled.

From losing a job as Lancelot did to finding employer-provided coverage too expensive, almost anyone can suddenly become uninsured.

"If you think this will never happen to you, think again," said Karen Pollitz, project director of the Health Policy Institute at Georgetown University. Here are some options to look into:

Buying from an insurer or health plan:

People seeking insurance coverage within 63 days of leaving a group health plan are guaranteed by law (the Health Insurance Portability and Accountability Act) to be offered a policy, and preexisting conditions have to be covered. But the cost can be prohibitive.

For those who have not been part of a group, buying an individual policy can also be expensive -- if they are even offered one. "This market is hard for healthy people, and it is impossible if you're not healthy or just a little bit unhealthy," Pollitz said.

During the application process, companies will ask about health history. People with preexisting conditions are often turned down or told those conditions won't be covered. Sometimes the condition that triggers a denial is seemingly innocuous, such as acne.

Insurers sometimes offer low-cost premiums with high deductibles, the amount you have to pay out-of-pocket before the insurance kicks in. Other low-premium policies might cover only a few doctors' visits per year, or a very small percentage of a hospitalization, leaving you with a high level of risk.


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