What Factors Affect Massachusetts Individual Health Insurance?
When looking for individual health care insurance policies, several factors must be evaluated before selecting a policy. There are the differences between HMO and PPO programs, the level of out of pocket costs (yearly deductibles and co-pays), and the financial strength of the insurance provider to consider. But, possibly, the most significant factor to impact your coverage is the health insurance provider's practices on medical underwriting of new applicants.
The medical underwriting requirement for individual health benefit policies is very different from what is required for group health care programs. In accordance with the law, in a group insurance plan, there should not be discrimination in coverage levels applied to any individual member of the group based on that member's health status. In contrast, for individual insurance plans, discrimination due to an individual's health status is routinely performed now and is totally legal! If a new applicant for an individual health insurance plan has a disability or existing medical condition, the insurance provider is free to refuse insurance to the applicant or may offer only coverage that excludes the health disability or condition.
This practice occurs because of the process of medical underwriting of each new health insurance policy which is applied to most new policies purchased in the individual insurance marketplace. What the concept of medical underwriting really means is that the health insurance provider is analyzing the potential financial risk attributable to the proposed policy due to the health status of the individual. When applying for new health coverage, consumers would be wise to call the medical underwriting staff of the insurance provider early in the process to learn how they treat various health issues.