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5.5.06
Politics and Economy:
How to Protect Yourself from
a Health Insurance Nightmare
More on This Story:
Simply having health insurance does not mean all your medical services will be covered. This week's show illustrates how a family already coping with illness can get stuck with overwhelming expenses even after insurance kicks in. But there are some proactive steps you can take to protect yourself from an insurance nightmare.


Understand Your State Rules

Rules and regulations regarding health insurance vary by state. State insurance departments provide information on company and agent licensing requirements, available products and other insurance industry issues. Many departments will also offer consumer alerts as well as advice on how to purchase insurance, frequently asked questions and ways to protect yourself from fraudulent plans. The National Association of Insurance Commissioners (NAIC) maintains an interactive map that links to state insurance departments. Use it to research your state's insurance information.

Find your state's insurance department.


Choose a Good Plan

The Agency for Healthcare Quality and Research of the U.S. Department of Health and Human Services offers an online consumer guide for choosing quality healthcare.

Another resource is The National Committee for Quality Assurance (NCQA), a nonprofit accrediting organization, which offers interactive 'report cards' for hundreds of health plans that care for commercially insured individuals and Medicare and Medicaid beneficiaries.

Create a health plan report card

The NCQA rates plans in five sub-categories looking at the following criteria.

  • Staying Healthy - Does the health plan help people maintain good health and avoid illness? Is a full spectrum of preventive care (screenings, check-ups) covered? Does the plan have proactive immunization programs?

  • Getting Better - How well does the plan care for people when they become sick? How does the plan evaluate new medical procedures, drugs and devices to make sure that patients receive safe and effective care?

  • Living with Illness - How well does the health plan help people manage chronic illnesses?

  • Qualified Providers - Does the health plan thoroughly check the credentials of all of its providers? How satisfied are members with general and specialty care? How well do caregivers communicate with patients and their families?

  • Access and Service - Do health plan members have access to the care and service they need? Does the health plan resolve grievances quickly and fairly? How quickly can members get appointments?

The Georgetown University Health Policy Institute has written a consumer guide, which is available online, for getting and keeping health insurance for each state and the District of Columbia.

Find the guide for your state here



(Sources: The Agency for Healthcare Quality and Research, Georgetown University Health Policy Institute, The National Association of Insurance Commissioners, The National Committee for Quality Assurance)

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