HispanicBusiness

YONKERS, N.Y., April 6 /PRNewswire-HISPANIC PR WIRE/ -- A new Consumer Reports investigation finds that many people who believe they have good health insurance actually have coverage so riddled with loopholes, limits, and exclusions that it won't come close to covering their expenses if they fall seriously ill. The full report is available in the May 2009 issue of Consumer Reports and online www.consumerreportsenespanol.org. The report includes a table listing the staggering treatment costs of many common conditions, leading off with late-stage colon cancer at $285,946.

At issue are so-called individual plans that consumers sometimes get on their own after losing their jobs or if they are self-employed. An estimated 14,000 Americans a day are losing their job-based coverage, cites Consumer Reports, and many may be considering individual insurance for the first time in their lives.

"Individual insurance has become a nightmare for consumers," says Nancy Metcalf, senior program editor at Consumer Reports. "It's expensive and difficult to get for people who have a less-than-perfect medical history. And people who do purchase a policy often don't understand what they've bought until it's too late and they're faced with hospital bills that their plan won't pay."

One couple, Janice and Gary Clausen of Audubon, Iowa, told Consumer Reports that they expect to be paying off medical debt for the rest of their lives because they didn't realize how much treatment can cost. The United Healthcare limited benefit plan they bought through AARP proved hopelessly inadequate after Gary Clausen received a diagnosis of colon cancer. His treatment cost well over $200,000.

Findings Show How Difficult it is for Consumers to Get Good Health Policies on Their Own
For its investigation, Consumer Reports hired a national expert to help evaluate a range of health plan policies and interviewed consumers who bought those policies, as well as insurance experts and regulators to learn more. Among the findings from the investigation:

-- Health insurance policies with gaping holes are offered by all kinds of insurers -- large and small. Most states do not task regulators with evaluating overall coverage.

-- Disclosure requirements about coverage gaps are weak or nonexistent, so it's difficult for consumers to figure out in advance what a policy does or doesn't cover.

-- In many states, people of modest means may have no good options for individual coverage. Plans with affordable premiums can leave them with crushing medical debt if they fall seriously ill, and plans with adequate coverage may have huge premiums.

"A good plan should pay for necessary care without leaving you with lots of debt," Metcalf says. "Decent insurance covers more than just routine care -- it's supposed to protect you in case of a catastrophically expensive illness. But many individual plans do nowhere near this job."

Consumer Reports identifies seven clues that a health plan might be junk:

-- Limited benefits. Do everything in your power to avoid buying a product labeled "limited benefit" or "not major medical" insurance -- a sure warning sign of inadequate coverage.

-- Low overall coverage limits. Health care is costly. Policies with coverage limits of $25,000 or even $100,000 are not adequate.

-- "Affordable" premiums. If premiums are very low, chances are good that the policy doesn't cover very much. To check how much a comprehensive plan might cost, Consumer Reports recommends visiting ehealthinsurance.com and examining the more expensive plans available in one's state.