BEND, Ore. (CNN/Money) – Forget stock options. More and more Americans are deciding to take jobs or stick with the ones they have because of health insurance.
"Insurance is the golden handcuffs for 2003 and beyond," said Kathleen Stoll, director of health policy for Families USA. "People who would like to work on their own or retire early can't because of insurance."
A survey of employees by Hewitt Associates last year found that health-care coverage is the most important benefit, outscoring compensation by a margin of two to one. Moreover, two-thirds of respondents said health coverage was a primary factor in their employment decision.
Thor Erickson, for one, traded the prestige of working as a chef in high-end restaurants for the health benefits that came with a catering job at a hospital. "Benefits were really the only positive thing about going to a corporation," the 34-year-old Bend, Ore., resident said.
Chuck and Andrea Pitts, meanwhile, are counting down the days until Andrea finishes her degree as a biomedical engineer.
"With any luck she'll work for a hospital with benefits," said Chuck, a small business owner in Atlanta. His and Andrea's insurance premiums have increased 35 percent a year for three years. "We pay $866 a month, which is more than our mortgage," he added.
Employers are critical
Fully two-thirds of Americans under age 65 rely on their employer for health insurance, according to Karen Pollitz, project director of Georgetown University's Health Policy Institute.
Pollitz's research shows that buying individual insurance coverage is increasingly not a viable option because it's too expensive, has too many exclusions or simply is not available. "Not everybody who wants to buy it can," she said.
In 2002, the number of uninsured Americans increased by nearly 6 percent to 43.6 million, according to the Census Bureau.
Even people with a perfect bill of health discover that obtaining comprehensive health coverage is no easy task. It's more of a challenge for those with more common health problems, such as asthma, and it's pretty much impossible for people with more serious conditions, such as HIV.
In 2001, Georgetown's Health Policy Institute conducted an extensive study on the individual insurance market.
"We found that affordable policies were available, but only to the youngest, healthiest people," said Pollitz, who led the study.
Researchers applied for insurance on behalf of seven hypothetical consumers -- ranging from "Alice" a 24-year-old with hay fever to "Greg" a 36-year-old with HIV. They submitted 60 applications per consumer to 19 different insurers and health maintenance organizations in eight different markets. (see table)
"Alice" had the best luck, with only 8 percent of her applications rejected. "Frank," a 62-year-old overweight smoker with high blood pressure was rejected 55 percent of the time, with premiums ranging from $2,928 to $30,048.
|Consumer ||Rejected applications ||Average premium |
|Alice, 24, has hay fever ||8 percent ||$1,656 |
|Bob, 36, has an old knee injury ||12 percent ||$1,764 |
|Crane Family; son has asthma ||0 percent * ||$5,460 |
|Denise, 48, survived breast cancer ||43 percent ||$3,912 |
|Emily, 56, suffers from depression ||23 percent ||$4,056 |
|Frank, 62, has high blood pressure ||55 percent ||$9,936 |
|Greg, 36, is HIV positive ||100 percent ||NA |
| * Some policies excluded son with asthma.|
| Source: Georgetown University Health Policy Institute|
All 60 of the applications submitted for "Greg" were rejected because of his HIV. When "Denise," a breast cancer survivor of seven years, was offered coverage (43 percent of her applications were rejected) it commonly excluded cancer of any kind.
But the individual market isn't difficult just for those with serious pre-existing conditions. "You can be a healthy 45-year-old woman and tied to your job because of health insurance," Families USA's Stoll said.
In fact, age-based price hikes start kicking in as early as 35. "Between the ages of 50 and 60 you could be looking at a rate hike of 6 to 7 percent a year," Pollitz said. How's that for a birthday gift?
Taking the plunge
Those who dare to find insurance on their own can begin searching for policies using online sites such as eHealthInsurance.com or Insurance.com.
Keep in mind, however, that quotes given online generally apply to people with a perfect health history. It's not until you go through a full-blown underwriting process that you'll know what kind of premium you'll really have to pay, Stoll said.
You might also see if there is a legitimate group, such as a trade association, that offers group insurance to its members. "As a word of caution, there are associations that are formed only for the purpose of selling insurance and don't actually offer group insurance," Stoll said.
Because insurance can be so difficult to get on your own, you might get the best results by working with a health insurance agent in your area. The Life and Insurance Foundation for Education recommends finding an agent through word-of-mouth references or by contacting your state insurance department.
Once you do manage to find viable policies, be prepared to spend quite a bit of time reading the fine print.
"Plans offered in the individual market are usually even harder to decipher than those offered by your employer," Stoll said. In particular, pay attention to exclusions for pre-existing conditions, out-of-pocket costs and any annual or lifetime caps on benefits.