211:. For individuals who pass individual medical underwriting where it is used, the average premiums they pay are lower than the average paid for employer-sponsored coverage (this comparison is based on the entire premium for employer-sponsored coverage, including both the employee and employer contributions). Factors that may contribute to this include: differences in age; less generous coverage in the individual market (higher beneficiary cost sharing); and a tendency for individual consumers to only buy benefits that they expect to need and use while group coverage may provide some benefits that most beneficiaries do not use. Individual policyholders are also more likely to report being in excellent health than are people covered by employer-sponsored health insurance, which may be a contributing factor. Premiums in the individual market rose less rapidly over the period 2002-2005 than did out-of-pocket premiums in the employer-sponsored market (17.8% versus 34.4%). The increase was larger for family policies than for single policies (25.3% for family policies; the increase for single policies was not statistically significant). These comparisons did not adjust for changes in benefit levels.
219:
consumers and improve access to coverage. Each has its own advantages and limitations. One 2008 study found that people of average health are least likely to become uninsured if they have large group health coverage, more likely to become uninsured if they have small group coverage, and most likely to become uninsured if they have individual health insurance. But, "for people in poor or fair health, the chances of losing coverage are much greater for people who had small-group insurance than for those who had individual insurance." The authors attribute these results to the combination in the individual market of high costs and guaranteed renewability of coverage. Individual coverage costs more if it is purchased after a person becomes unhealthy, but "provides better protection (compared to group insurance) against high premiums for already individually insured people who become high risk." Healthy individuals are more likely to drop individual coverage than less-expensive, subsidized employment-based coverage, but group coverage leaves them "more vulnerable to dropping or losing any and all coverage than does individual insurance" if they become seriously ill.
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and lower income individuals. One study found that among individuals who lack other sources of health coverage, the percentage purchasing individual insurance increases steadily with income. However, even among those with incomes four times the federal poverty level, only about a fourth buy individual coverage. The self-employed, who can tax-deduct their premiums, are more likely to purchase than other individuals. The researchers concluded that affordability appears to be a key barrier to coverage in this market, and that any premium subsidies would likely have to be substantial to be effective. The researchers note that other factors such as health status and the complexity of the market can also affect the purchase of individual health insurance, but conclude that they are unlikely to be the primary drivers of low coverage rates.
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304:(NAIC) provide some degree of uniformity state to state. These models do not have the force of law and have no effect unless they are adopted by a state. They are, however, used as guides by most states, and some states adopt them with little or no change. The primary NAIC models affecting the individual health insurance market are:
191:
receive any tax benefit. The range of products available is similar to those provided through employers. However, average out-of-pocket spending is higher in the individual market, with higher deductibles, co-payments and other cost-sharing provisions. Major medical is the most commonly purchased form of individual health insurance.
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Research confirms that the individual health insurance market is sensitive to price. Estimates of demand elasticity in this market vary, but generally fall in the range of -0.3 to -0.1. It appears that price sensitivity varies among population subgroups and is generally higher for younger individuals
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Many states allow medical underwriting of applicants for individually purchased health insurance. An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing conditions. A number of proposals have been advanced to limit the effect of underwriting on
190:
for their health insurance and can buy health insurance with additional tax benefits. According to the US Census Bureau, about 9% of
Americans are covered under individual health insurance. In the individual market, consumers pay the entire premium without an employer contribution, and most do not
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reported that competition was increasing in the individual health insurance market, with more insurers entering the market, an increased variety of products, and a broader spread of prices.
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Pauly, Mark V.; Lieberthal, Robert D. (May 6, 2008). "How Risky Is
Individual Health Insurance?". Web exclusive.
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purchased directly by individuals, and not those provided through employers. Self-employed individuals receive a
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Fundamentals of
Underwriting in the Nongroup Health Insurance Market: Access to Coverage and Options for Reform
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Premiums in the
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670:"Snapshots: Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance: 2004–2007"
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An
Analysis of the Distribution of Cost-Sharing Levels in Individual and Small-Group Coverage
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Individual health insurance is primarily regulated at the state level, consistent with the
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Individual Health
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Please help update this article to reflect recent events or newly available information.
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568:. AcademyHealth Meeting. Vol. 22. Boston, MA. Abstract no. 3899. Archived from
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611:"Health Reform Bill Summary: The Top 18 Immediate Effects Of The Health Care Bill"
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All of these models have been implemented in one form or another by most states.
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519:(Policy Report). Changes in Health Care Financing & Organization (HCFO).
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The
Advertisements of Accident and Sickness Insurance Model Regulation; and
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Income, Poverty, and Health
Insurance Coverage in the United States: 2007
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The
Uniform Individual Accident and Sickness Policy Provision Law (UPPL);
713:"Subsidies and the Demand for Individual Health Insurance in California"
357:
711:; Escarce, Jose J.; Kapur, Kanika; Yegian, Jill M. (October 2004).
781:"Baby Kendra's $ 300,000 Bill Pains Insurers, Inspires Candidates"
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The Cost And
Benefits Of Individual Health Insurance Plans: 2007
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The Accident and Sickness Insurance Minimum Standards Model Act;
891:. Huebner School series. Bryn Mawr, PA: The American College.
864:"More Health Insurers Competing In Individual Coverage Market"
233:
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Premiums can vary significantly by age. In states that allow
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The Price Sensitivity of Demand for Nongroup Health Insurance
562:"Risk Segmentation in the Individual Health Insurance Market"
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deal primarily with the United States and do not represent a
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Federal laws affecting individual health insurance include:
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Chovan, Teresa; Yoo, Hannah; Wildsmith, Tom (August 2005).
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Tucker, Elizabeth M.; Hogan, Lindsey (September 2007).
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Bertko, John; Yoo, Hannah; Lemieux, Jeff (July 2009).
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Health Insurance Portability and Accountability Act
637:"Gap in health care law's protection for children"
816:(Background paper). National Health Policy Forum.
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762:How Non-Group Health Coverage Varies with Income
760:Jacobs, Paul; Claxton, Gary (January 30, 2008).
668:DiJulio, Bianca; Claxton, Gary (March 3, 2010).
300:. Model acts and regulations promulgated by the
460:Bernard, Didem; Banthin, Jessica (April 2008).
302:National Association of Insurance Commissioners
376:Health insurance coverage in the United States
106:The examples and perspective in this article
8:
609:Binckes, Jeremy; Wing, Nick (May 25, 2011).
467:(Report). Statistical Brief. Vol. 202.
337:Newborns' and Mothers' Health Protection Act
635:Alonso-Zaldivar, Ricardo (March 24, 2010).
50:Learn how and when to remove these messages
469:Agency for Healthcare Research and Quality
406:(Report). U.S. Census Bureau. August 2008.
205:Patient Protection and Affordable Care Act
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284:Learn how and when to remove this message
162:Learn how and when to remove this message
144:Learn how and when to remove this message
887:O'Hare, Thomas P. (2000). "Regulation".
535:"Health Insurance Options for Americans"
497:. August 2004. p. 5. Archived from
256:Relevant discussion may be found on the
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180:individually purchased health insurance
572:on 2008-10-13 – via NLM Gateway.
268:to additional sources at this section.
932:Health insurance in the United States
927:Medicare and Medicaid (United States)
488:Update on Individual Health Insurance
371:Health insurance in the United States
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889:Individual Medical Expense Insurance
344:Women's Health and Cancer Rights Act
249:relies largely or entirely upon a
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862:Levick, Diane (August 18, 2008).
31:This article has multiple issues.
729:10.1111/j.1475-6773.2004.00303.x
437:America's Health Insurance Plans
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809:Merlis, Mark (April 13, 2005).
560:Herring, B.; Pauly, M. (2005).
317:The Unfair Trade Practices Act.
209:pre-existing medical conditions
39:or discuss these issues on the
521:Robert Wood Johnson Foundation
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779:Marcus, Aliza (May 7, 2008).
493:(Report) (revised ed.).
381:Health insurance marketplace
694:Congressional Budget Office
120:, discuss the issue on the
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351:Fair Credit Reporting Act
70:This article needs to be
766:Kaiser Family Foundation
717:Health Services Research
709:Buntin, Melinda Beeuwkes
675:Kaiser Family Foundation
654:– via Google News.
566:Abstr AcademyHealth Meet
495:Kaiser Family Foundation
356:Federal rules governing
539:Health Management Corp
446:on November 27, 2007.
298:McCarran-Ferguson Act
869:The Hartford Courant
791:on February 22, 2012
692:(Background paper).
262:improve this article
224:the Hartford Courant
201:medical underwriting
126:create a new article
118:improve this article
876:on August 22, 2008.
707:Marquis, M. Susan;
615:The Huffington Post
358:Medicare supplement
592:Forrester Research
696:. August 1, 2005.
647:on March 27, 2010
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921:Categories
795:2008-05-10
764:(Report).
651:2010-03-24
621:2010-03-22
617:. Oath Inc
590:(Report).
435:(Report).
387:References
230:Regulation
134:April 2017
36:improve it
360:policies.
266:citations
258:talk page
195:Economics
122:talk page
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