With increased attention on pre-existing conditions and the individual insurance market, we wanted to share the following information with you:
- The vast majority of people under the age of 65 get their health care coverage through their employer. People receiving coverage through their employer are guaranteed coverage regardless of pre-existing conditions, and the premiums they pay are not based on their health status.
- The individual insurance market functions much differently. In an environment where some people choose not to purchase coverage, applicants undergo an underwriting process to keep coverage as affordable as possible for all policyholders. It provides a necessary incentive for people to purchase coverage before they need it, and to maintain coverage over time. According to the latest Census Bureau data, seven percent of people under the age of 65 get their coverage through the individual insurance market.
- Throughout the health care reform debate there was broad agreement that requiring insurers to provide a policy to any applicant without varying premiums based on health status cannot work without an individual mandate: What They Are Saying: The Link Between Market Reforms and the Mandate.
- Coverage in the individual market is more affordable and accessible than is widely believed. In fact, according to AHIP’s latest individual market survey, 87 percent of people who applied for individual coverage were offered a policy.
- Health plans have pioneered programs and services to help improve care for patients with chronic health conditions:
- AHIP Issue Brief: Transforming Care Delivery
- Recent AHIP testimony to Senate HELP Committee on delivery system reform
- Article in September Issue of Health Affairs: Health Plans and Providers Partnering to Advance Accountable Care
- AHIP Innovation Series highlighting health plan innovations in health care delivery and quality improvement