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Sounds Like A Must-Read: Health Insurance Industry Insider Tells All

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Q. Knowing what you know about how the industry works, what is the most important piece of advice you can offer readers when it comes to choosing and paying for health insurance?

A. I would encourage people to completely ignore the marketing materials you receive from the insurers. The information is geared to persuade people to buy the product. It doesn’t explain the benefits clearly.

If you’re trying to buy insurance in the individual market, you should know that those insurers are looking to sell coverage only to young and healthy people. If you aren’t particularly young or healthy, you’ll be charged more or have limited benefits or both. And even if you get insurance through your employer, you need to read carefully.

In either case, always ask the insurer or your benefits department for a copy of the actual policy you’re considering. Read it, and find out what the benefits are and what your financial obligations — co-pays, co-insurance, deductibles, premiums — will be.

Don’t expect everything that you need will be covered in the policy. Things like maternity benefits, transplant coverage and of course experimental procedures may be excluded. That’s the kind of information you will never see in the marketing materials, but it’s vital to making your choice.

This program aired on February 18, 2011. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.

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