why so few choices in health insurance?

[DayDreaming]

This might belong in the political forum, but: why are there so few choices available for individual health insurance?

I'm currently covered by COBRA but will need to get my own insurance early next year. Ehealthinsurace.com shows me 21 plans from 3 health insurance companies. Why are only 3 insurers available to me? Is it the insurance company's choice where they offer coverage, or some government agency restricting what's available to me? Or are there some other Machiavellian forces at work?

 

[ziggy29]

It largely depends on your state. Some insurers don't do business in some states because they don't think it will be profitable. It could have to do with the regulatory environment in the state or some other factor.

 

[teejayevans]

This might belong in the political forum, but: why are there so few choices available for individual health insurance?

I'm currently covered by COBRA but will need to get my own insurance early next year. Ehealthinsurace.com shows me 21 plans from 3 health insurance companies. Why are only 3 insurers available to me? Is it the insurance company's choice where they offer coverage, or some government agency restricting what's available to me? Or are there some other Machiavellian forces at work?

Last I check they don't represent all the insurance companies, BCBS
being the big one.
TJ

 

[DayDreaming]

TJ - one of the 3 choices that ehealthinsurance.com shows me is BCBS.

 

[ERD50]

Interesting Question.

In other Health Care threads, we've discussed the problem, and "nationalizing" the regs is one proposed solution, but I don't think I've ever heard a clear explanation as to why there are so few cos in each state.

I suppose it has to do with the burden of meeting the requirements and setting up shop under the various state regs. But I also wonder if there isn't a little wink/nod going on that ends up in "territory splitting" (illegal, but maybe un-provable?)? Since Co X set up in IL, Co Y sets up in WI and just "never gets around" to applying in IL and vica-verse? I guess I'd need to see a chart of which cos are licensed in each of the 50 states (plus DC).

-ERD50

 

[Martha]

Good question. I'll poke around some.

 

[JOHNNIE36]

Maybe I'm missing something here but isn't that one of the big arguments going on in the country? Lots of conservatives and media pundits are harping that if we are really serious about reducing health care costs, the government should eliminate restrictions on companies selling health insurance across state lines. That is the part I don't get, BCBS sells across state lines, United Health Insurance and Humana also. I don't understand it and to be honest haven't looked into that subject. Right now I'm happy with what I have but would like to look at many other options.

 

[teejayevans]

TJ - one of the 3 choices that ehealthinsurance.com shows me is BCBS.

maybe state dependent, for NC, no BCBS.
TJ

 

[teejayevans]

Maybe I'm missing something here but isn't that one of the big arguments going on in the country? Lots of conservatives and media pundits are harping that if we are really serious about reducing health care costs, the government should eliminate restrictions on companies selling health insurance across state lines. That is the part I don't get, BCBS sells across state lines, United Health Insurance and Humana also. I don't understand it and to be honest haven't looked into that subject. Right now I'm happy with what I have but would like to look at many other options.

Actually no, when I talked to BCBS, if I move from one state to another
they told me I have to reapply. The insurance rules change from state
to state. UH did tell me that I wouldn't have to reapply, but they also
raise my rates by 20% the first year.
TJ

 

[brewer12345]

Dude, you live in NJ. We are in perhaps the most insanely tightly regulated insurance market in the country. As a result, the vast majority of insurers simply decline to do business here. So we have little choice and ridiculously high prices. Welcome to the People's Republic of NJ.

 

[DayDreaming]

Regarding BCBS, it's interesting that they have a different name in each state, sometimes more than one name. I guess that's to be able to work under the different state & local regulations.

Also seems odd that the insurance company I had through my former employer, and still have via COBRA, is not available to me as an individual.

 

[brewer12345]

BCBS operates through numerous differentlegal entities. So BCBS plans in one state might be ofered by one company and by another company in a different state. Welcome to the wonderful world of insurance regulation.

 

[Martha]

Regarding BCBS, it's interesting that they have a different name in each state, sometimes more than one name. I guess that's to be able to work under the different state & local regulations.

Also seems odd that the insurance company I had through my former employer, and still have via COBRA, is not available to me as an individual.

I understand that a number of insurers who serve the group market don't serve the individual market at all.

 

[Gotadimple]

BCBS is an association. They have licensees. Every plan is a licensee of the Blue Cross and Blue Shield Association (like every McDonald's is a licensee of the McDonald's Corp). They are not an insurance carrier.

In some states, Blue Cross and Blue Shield are separate companies and separate licensees of BCBSA.

So:

If you have coverage in New York from Empire Blue Cross and move to Oregon, and want to stay with a Blue Cross carrier, you would apply to Regence BlueCross BlueShield of Oregon.

 

[MayGray]

Has anyone here had experience with moving from state to state while covered by a medigap policy? I'm trying to figure out how to get overlapping coverage. In order to get a policy in the new state I will need a certificate of creditable coverage which I cannot get while still covered in the old state.

I wish we had federal rather than state-by-state regulation of health insurance so as to avoid this kind of complication.


(PS sorry if this is off-topic -- it seemed to follow from the recent posts)

 

[Martha]

When I recently bought insurance and needed the certificate of credible coverage. The insurer said I could apply on the date the old policy was terminated and my application date would be my coverage effective date after all was processed. That made me too nervous so I applied early and enclosed a letter saying that I would provide the certificate when my insurance terminated.

YMMV as this wasn't medigap.

 

[DayDreaming]

I thought I found some options for helathcare when I came across this site: Fractured Atlas whose mission is

... to help artists and arts organizations function more effectively as businesses by providing access to funding, healthcare, education,...
​

Since I'm an artist, I thought GREAT! Until I got to their page about health care options in my state of residence, which says:

Health insurance is regulated on a state-by-state basis. Each state insurance department gets to decide which insurance plans can be offered to its residents.
Unfortunately, New Jersey hasn't yet given the green light for the Aetna plans that are available to Fractured Atlas members throughout most of the country. We're sorry about that, but there's really nothing we can do.
​

Oh well.

 

[Martha]

I thought I found some options for helathcare when I came across this site: Fractured Atlas whose mission is

... to help artists and arts organizations function more effectively as businesses by providing access to funding, healthcare, education,...
​

Since I'm an artist, I thought GREAT! Until I got to their page about health care options in my state of residence, which says:

Health insurance is regulated on a state-by-state basis. Each state insurance department gets to decide which insurance plans can be offered to its residents.
Unfortunately, New Jersey hasn't yet given the green light for the Aetna plans that are available to Fractured Atlas members throughout most of the country. We're sorry about that, but there's really nothing we can do.
​

Oh well.

The Aetna plans have underwriting. NJ does not allow underwriting.

 

[Buckeye]

We found our individual health insurance through a local broker. I looked on ehealthinsurance to know what to expect in terms of premiums and benefits but the broker found a policy that worked for us living in OH and when we moved to FL (did not have to reapply). I hadn't heard of the company, American Community, but they have been in business for many years. It's also the company the broker's family has used for years.

Using a broker cost us nothing and he was readily available to answer all my questions. If he didn't know the answer, he knew who to contact at American Community because of their long relationship.