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Finding the Right Individual Plans at the Right Time: Helping the Uninsured
By Laurie Brubaker, senior vice president and head of Aetna Individual Markets

"Jessica," a 23-year-old who just graduated from UCLA, is excited about finding her first new "career" job and moving out on her own. However, for the time being, she is waiting tables at a local restaurant and living at home to try to save money.

"Karl" is a 39-year-old father of two from San Diego, who recently left his job to follow his dream – running his own business.

"Nicole," a 62-year-old from Sacramento, just retired and is excited about traveling around the world with her husband of 36 years.

These three individuals are at very different stages of their lives, and chances are, they probably don’t have a lot in common. However, one trait they all may share is difficulty finding health insurance.

For these individuals, the ability to obtain health insurance through an employer -- which is still the way the majority of Americans obtain their health benefits – is not available. Another option for those looking to obtain insurance with group rates is to work with a professional association. However, a story in the Los Angeles Times on March 27 reported that many of these groups are dropping coverage options for their members. Results from a survey from the American Society of Association Executives were included in this story: It was noted that fewer than a quarter of 1,020 professional and small-business associations surveyed in February 2007 offered medical coverage, even though a majority of the groups said they would like to.

Without these options, the chances are good that Jessica, Karl and Nicole might join America’s uninsured population of almost 45 million. This is an especially difficult problem for the state of California, which has an uninsured rate of 18 percent, according to recent Census estimates.

Segmented Plans and Information
One of the solutions to this issue is the increased offering of individual health care coverage. These plans, which can be purchased directly by consumers from insurance carriers, are not the one-size-fits-all group policies. Instead, these plans have unique aspects that appeal to individuals based on their life stages. Here are some groups that commonly are among the uninsured, as well as some of the benefits that they are most interested in:
  • College Students/Recent Graduates - Young adults make up the largest age group of uninsured Americans, as nearly 1 in 3 of the uninsured are between 18 and 24 years old. In many cases, this group is healthy and focused on other financial priorities, such as paying down credit card debt, making rent on their first new places and paying off college loans. For many in this group, health benefits are just not a priority – in fact, an August 2006 Ipsos Public Affairs survey found that 44 percent of the young workers surveyed in this age group would rather pay their monthly cell phone bill than pay a health benefits premium.

    However, this group is interested in health care benefits if it can help them look and feel their best. That same Ipsos survey found that of the young workers with health benefits, 85 percent said dental care was the most valuable, ranking it above vision, counseling/therapy and smoking cessation classes offered by health benefits plans.

  • Self-Employed – This is another group that makes up a huge portion of the uninsured population. Some estimates actually say that 50 percent of the entire uninsured population are self-employed or work at small businesses.

    Most self-employed people want to have insurance (and offer it to their employees), but in many cases, the cost is prohibitive. Affordable options and providing value and best-in-class customer service is important to this group. Another unique option that is appealing to sole proprietors is an affinity program that allows them to get the same discounts their insurance carriers receive on important business products and services such as computers and office supplies.

  • Early Retirees – Individuals who retire before 65 may run into a significant problem, as they no longer have health insurance through an employer, and Medicare is not yet available for them. An Individual plan could be an attractive option at this time, as it can take care of a person’s health care needs and financial security. In many cases, a plan for this group may include higher levels of coverage, as the likelihood of health problems unfortunately increases with age.
The strategy of segmenting based on life stages is not only evident in the different plan designs and benefits offerings, but also in how information is presented to consumers. One website that breaks down health benefits information in this way is Plan for Your Health.

This website offers information for consumers on health benefits, such as a glossary of common health benefits terms or a link to order an innovative guide for consumers called Navigating Your Health Benefits For Dummies®. While this and other content on the site can be used by an individual, most of the articles are separated into different categories, such as Career, Marriage, Family, Living Single and Retirement. There are also interactive tools on the site that target specific groups, such as the Baby Expense Calculator or the Planning for a Healthy Retirement’ quiz. These features allow consumers to more easily navigate the site and find the information that is truly important to them

An offshoot of this website, All About The Benefits, has similar information, but is targeted toward individuals who are just graduating from high school and college and just entering the workforce. The articles on this site are very short and to the point, targeted to this audience. The site also includes videos and a podcast that can be viewed online or downloaded.

Individual Plans Can Help
With health care costs continuing to grow at double-digit rates, the number of those without health care coverage will continue to escalate. However, the uninsured are not a homogeneous group, so a comprehensive variety of solutions is necessary to bring low-cost, high-quality health care to a population that includes college students, small business and low-wage employers, and racial and ethnic minorities, among others.

While it is not a cure-all solution, the increased offering of health benefits products for individuals can help decrease the uninsured population in our country by giving options to individuals who currently have none. Providing coverage for more individuals in our country will have tangible benefits, such as the decrease in health care costs that are currently shifted to the government, medical professionals, and the insured population in the form of annual insurance premium hikes because of increased use of medical services by the uninsured. In addition, people like Jessica, Karl and Nicole can have the peace of mind that comes with having health benefits and knowing they have insured their own and their families’ health and financial well-being – a priceless benefit.

A version of this story was published in the May 2007 California Broker. For more information about Aetna's Individual plans, please go to www.AetnaIndividual.com or call 1-800-MY-HEALTH (1-800-694-3258).
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