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Finding a path through the health insurance 'gobbledygook'

The tale of one journalist's navigation through the individual health insurance market in a rural area.

April 23, 2011|Lisa W. Drew | Kaiser Health News

My ZIP code is a black hole for individual health insurance.

That's what I recently discovered when I tried to find the coverage I want at an affordable price. What hubris I had.

My story started in 2009, when my position as a journalism professor at a small college was eliminated, and I lost my health benefits along with the job. In the ensuing months, as the clock ticked on my COBRA extension, I began to focus on finding a new health plan. I thought it would be a matter of dealing with mild sticker shock and doing comparative shopping. I was wrong.

As an experienced writer and researcher, I am used to making calls, asking questions and digging through hard-to-understand details. But it never occurred to me that the answers I uncovered about Tompkins County, N.Y. -- a paradise of farmland, lakes and waterfalls close to the cultural attractions of Ithaca, home for me and Cornell University -- would be so frustrating. It turns out it's one of the state's worst places to find good individual health coverage.

When I tell people about my dilemma, they get curious -- even participatory. "Did you try a professional group?" they ask. "Did you try an online broker?" (Yes and yes.) Maybe they get caught up in my story because, unlike many people with tales of insurance woes, I'm in my fifties and healthy. My story doesn't involve a medical condition that's unsolvable or hard to talk about. Or maybe it's just that my experience lights a path, however convoluted, through the insurance gobbledygook.

I started my quest with Aetna, my COBRA insurer. Under New York state law, I thought I had "conversion rights" -- meaning I could convert my former employer's group coverage, the basis for my COBRA plan, to individual coverage. Though the full monthly cost was already $565, and I worried I wouldn't be able to afford any increases that kicked in when it became an individual plan, it was great insurance -- providing excellent benefits and the ability to choose my own doctors. But it turned out my cost concerns were not even relevant. There is a caveat in the law: self-insured employers are subject to federal, not state, regulation. And because my former employer is self insured -- meaning Aetna administers the plan but the college assumes all the financial risk -- the conversion option did not exist.

After this idea evaporated, I explored possibilities on the website of The Freelancers Union, a professional association that offers its own health insurance in New York. Five plan choices popped up. Great, I thought. Then I clicked further to read about the plans' residency requirements and up came a map. The right side of the state -- covering 34 counties that share borders with New Jersey, Pennsylvania, Connecticut, Massachusetts, Vermont and Canada -- was colored in blue. These counties are the lucky ones. Those on the left -- 28 counties that border more of Pennsylvania and Canada, extending all the way to Lake Erie and Lake Ontario -- were white, meaning no Freelancers Union health insurance. That's where Tompkins County is.

This development was crushing. Somewhere along the way, the notion had lodged in my head that if I ever turned to freelance writing as my full-time job, I could get benefits through this type of organization. But -- at least as far as I could tell -- there are no such groups with health plans in my area.

I felt stupid. I also was getting curious, which happens whenever I feel stupid. The reporter in me wanted to know what the heck was going on. But the consumer in me needed a health plan. So I kept looking.

I tried other websites, starting with AARP. The site directs consumers to an AARP-branded Aetna plan. I entered my ZIP code and got the same response: the plan was "not available in your area." Next, at a top-rated insurance broker site, my ZIP code brought up one result. The $561-a-month GHI policy covered annual physical and gynecologic exams, prescription drugs with a co-pay, hospitalization and outpatient surgery. But it did not cover, among other things, any other office visits; inpatient physical therapy; ER professional charges; diagnostic admissions; and diagnostic lab tests. To me, that seems like too much money to spend for what amounts to catastrophic coverage.

Curiosity was getting the better of me, so I did some random comparisons on the same website. Zip codes in the District of Columbia; Seattle; Fairbanks, Alaska; and New York City offered 80, 45, 56 and 16 insurance choices, respectively. I also tried random rural areas. Residents of Aladdin, Wyo., had 27 plan choices, starting at $380 a month. Residents of Amelia, Neb., had 87, starting at $133.05.

In search of clarity, I visited the New York state insurance website and discovered a whole new possibility: Healthy NY, a subsidized program for low-income people. Several different insurers offer the same basic menu of coverage through different regional HMOs, which charge different rates.

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