California Health Insurance Executives Testify Before Congress in March

Congress is scrutinizing Health Insurance for California by challenging the reasons that prevent many people from obtaining health care coverage. When the largest health insurance company in the U.S. (WellPoint, Inc.) proposed raising monthly premiums by up to 39 percent in California, Congress summoned WellPoint chief executives. WellPoint postponed its premium increases until May 1st 2010, and California’s insurance commissioner will decide whether to allow the increases.In short order, Congress expanded investigation of Health Insurance in California to look at coverage being refused and medical claims being denied as “preexisting conditions.” Chief executives from three more of the country’s largest for-profit health insurers (Aetna, Humana, and UnitedHealth Group) were summoned to appear before the House Committee on Energy and Commerce and its investigations subcommittee on March 23rd.Congress asked the companies to provide internal documents and e-mails about guidelines, practices, and underwriting policies for the last five years. These companies have been asked to show average premiums and increases, as well as maternity coverage for individuals by March 12th. These four companies sell health insurance policies for individuals to approximately 17 million Americans without health coverage from work.Need for Maternity Coverage in California Health Insurance PlansLooking at maternity coverage is important because woman ages 18 to 29 are the most likely group in the U.S. to lack health insurance. With just 59 percent of these women having health insurance through an employer, these young women comprise the group that is least likely to have health insurance from work. One-fourth of these women have no health insurance at all, yet 3.5 million pregnancies occur among the 21 million women who are ages 19 to 29 each year.As in third-world countries, lack of health care hits babies the hardest. Uninsured pregnant women are 60 percent more apt to delay prenatal care, three times more likely to suffer adverse outcomes, and their babies are 30 percent more likely to die.Lower California Health Insurance Rates Found by Independent AgentsPremiums and benefits vary greatly between insurance companies. Even insurance companies that are raising premiums, may have alternative plans with higher deductibles and lower premiums.Look for Websites that compare plans and offer quotes from a range of companies to get a feel for benefits and prices. Independent agents (those who work with many different insurance companies) may know which insurers have more lenient underwriting for people with back problems, for instance. Independent agents can also appeal if you are denied coverage, or are assessed a higher rate because you have pre-existing conditions.Compare California Health Insurance Plans to Get the Most for Your MoneyWhen comparing policies look at the annual deductible, the percentage you pay for a medical service after a deductible is met (coinsurance), and the annual out-of-pocket maximum. That maximum is how much you have to spend on co-pays, coinsurance, and other costs before the insurance company covers any expenses for the year.Check whether doctor visits are covered, and whether hospital stays have limited coverage. Look at which doctors and hospitals are in-network, too. Some individual plans exclude maternity coverage, but separate policies deal specifically with maternity and prenatal care.If you aren’t taking prescription drugs, you can save by eliminating that coverage. If you are using prescription medications, research the cost of buying through discount drug programs at King Soopers, Wal-Mart, or other large chains.Be careful about letting coverage lapse while you’re looking for a better policy. Events during a coverage lapse might make you ineligible for coverage. For example, insurance companies may not cover birth or prenatal care if there has been a gap in coverage.More Help for Maternal and Child ServicesMaternal and child services are also available for women with low incomes who are pregnant, and have children under the age of 22. A program called Women, Infants and Children (WIC) provides education about nutrition and child care for woman with low incomes, woman who are breastfeeding, and postpartum women. WIC also provides health coverage for children under five.Even if you do not qualify for the above programs, you may still have access to care through free clinics, prescription drug assistance plans, or temporary state insurance. Your best bet may be to educate yourself about how health care insurance works, and find an independent agent that will take the time to listen to your needs and help you navigate the insurance jungle.