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The State of the Individual Market

Fact Sheets for the 50 States and DC

SOURCE: iStockphoto

Health care insurers across the country find unique ways to get out of offering coverage.

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Fact sheets

Alaska | Alabama | Arkansas | Arizona | California | Colorado | Connecticut | District of Columbia | Delaware | Florida | Georgia | Hawaii | Iowa | Idaho | Illinois | Indiana | Kansas | Kentucky | Louisiana | Massachusetts | Maryland | Maine | Michigan | Minnesota | Missouri | Mississippi | Montana | North Carolina | North Dakota | Nebraska | New Hampshire | New Jersey | New Mexico | Nevada | New York | Ohio | Oklahoma | Oregon | Pensylvania | Rhode Island | South Carolina | South Dakota | Tennessee | Texas | Utah | Virginia | Vermont | Washington | Wisconsin | West Virginia | Wyoming

Report: Too Sick for Health Care: How Insurers Limit and Deny Care in the Individual Health Insurance Market

Insurers limit care by offering those in the individual market weak benefits, and sometimes excluding benefits all together. Insurers will sometimes even cancel an insurance policy once a customer starts making costly claims. Study after study has documented that people with pre-existing conditions can find it nearly impossible to get the coverage they need, or face high costs in trying to purchase it.

One way insurance companies limit care is by offering coverage on the individual market that has a weaker benefit package than most employers provide. Despite these smaller benefit packages, individual insurance policies also usually come with high cost sharing, such as deductibles that average $2,000 for PPO coverage.

Insurers also exclude coverage for medical conditions that individuals know they need. Insurers do this by defining pre-existing conditions as broadly as they can and then excluding those preexisting conditions from coverage.

What’s more, it is possible for insurance companies in the vast majority of states to cancel coverage once insurers discover that expensive claims are being made on the policy. In a game of “gotcha,” insurers can compare the original application to a policyholder’s medical history to find any discrepancy—no matter how small, innocent, or irrelevant—in an effort to cancel coverage. This can happen even years after the policy was purchased and in the face of complex insurance applications. Individuals who have their coverage canceled or rescinded are often left with large medical bills and no insurance moving forward just when they need it the most.

Insurance companies will use a range of reasons to limit health insurance on the individual market based on who wants to buy it, including prescription drug use, height and weight, age, gender, and occupation.

Fact sheets

Alaska | Alabama | Arkansas | Arizona | California | Colorado | Connecticut | District of Columbia | Delaware | Florida | Georgia | Hawaii | Iowa | Idaho | Illinois | Indiana | Kansas | Kentucky | Louisiana | Massachusetts | Maryland | Maine | Michigan | Minnesota | Missouri | Mississippi | Montana | North Carolina | North Dakota | Nebraska | New Hampshire | New Jersey | New Mexico | Nevada | New York | Ohio | Oklahoma | Oregon | Pensylvania | Rhode Island | South Carolina | South Dakota | Tennessee | Texas | Utah | Virginia | Vermont | Washington | Wisconsin | West Virginia | Wyoming

Report: Too Sick for Health Care: How Insurers Limit and Deny Care in the Individual Health Insurance Market

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