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CNN Live Saturday

Dollar Signs: Picking The Right Health Insurance

Aired July 17, 2004 - 16:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


FREDRICKA WHITFIELD, CNN ANCHOR: I'm Fredricka Whitfield. DOLLAR SIGNS is coming up next. But first, now in the news. Marion Jones pulls out of the 200 meters in the Olympic trials. She didn't say why. Jones is expected to hold a news conference in about 30 minutes.
American Lance Armstrong continues rolling toward a possible six Tour de France wins. Today, he clinched the 13th stage, closing within 22 seconds of the overall leaders. The race ends next Wednesday in Paris.

Well, welcome to DOLLAR SIGNS, where we help you get the most for your money. Today's topic is health insurance. Do you have enough, and do you have the right kind? With so many different health plans out there, my guests are going to help you sort through what's best for you.

Mila Kofman is an assistant research professor at Georgetown University's Health Policy Institute in Washington, and Trudy Lieberman is the director of the Center for Consumer Health Choices at the Consumers Union in New York. Good to see both of you, ladies.

MILA KOFMAN, GEORGETOWN UNIVERSITY: Thank you.

TRUDY LIEBERMAN, CONSUMERS UNION: Thank you.

WHITFIELD: Well, medical debt is huge in this country. And we decided now is a good time to help offer people some ideas as to how to tackle their medical debt, how to get out of it, and then how to choose the right medical policies, especially for those who are unemployed or, perhaps, who are working for themselves.

So let's begin with, you know, one scenario. Let's talk about, perhaps, the individual or the family. They don't have medical insurance, but they do have medical needs. Mila, what is that person or that family's options?

KOFMAN: First of all, they should go to our Web site, which is HealthInsuranceInfo.net. We have a consumer guide on health insurance for each state, including the District of Columbia. That's the best way to learn about the options that they may have.

Second of all, that family or that individual should remember, when they're thinking about comprehensive health insurance, it does two things for them -- a good policy, that is. One, it will give them access to medical doctors, to hospitals when they need medical care, and also, it will give them financial security. So when they get sick or they come down with a chronic disease, it won't mean that they'll lose everything, their life savings, their house, everything. So those are the things that I would keep in mind when shopping around for health insurance.

WHITFIELD: All right. We want to continue to urge people to send their email questions as well as call in. We've got our first caller on the line, Trudy. Her name is Jeanetta, in Utah, and she's got a question about insurance for the elderly -- Jeanetta. All right, it looks like we're having a problem with that phone line. So we'll try to return to that in a moment.

Well, Trudy, let me ask you then. There are a number of families who, perhaps, don't have insurance. They have medical needs, but they have accumulated quite a bit of medical debt. What do you recommend for that family or individual who has collected quite a bit of debt, but they still have some medical needs in which to get attended to?

LIEBERMAN: Well, the problem that they may have is being able to afford a policy. If people have to go into what we call the individual market to buy health insurance, they're going to find very, very high premiums. When Consumer Reports looked at the individual market a couple of years ago, we found that some policies for family coverage were as high as $16,000 a year.

Some of them, of course, were lower, but they were still in the $8,000 to $10,000 range. So a family with medical debt is going to be adding considerable amounts of money to their debt burden already.

WHITFIELD: All right. Jeanetta, in Utah, appears to be back on the phone with us and has a question about insurance for the elderly -- Jeanetta.

CALLER: Thanks for taking my call. My father is 82-years-old, World War II veteran, and unable to receive adequate healthcare and prescription medication at a reasonable amount of money. And so, I'm just so worried that he, being a World War II veteran, can't find health insurance life insurance, any of the World War II veterans, what happens to people like him and other people that may not be on veterans' benefits?

WHITFIELD: Mila, why don't you tackle that first?

KOFMAN: First of all, he should contact his local VA to see if there are any programs he may qualify for. Sometimes the local VA hospital will provide for prescription drugs that he may need. So that may help him out. Also, I don't know if he's on Medicare, but Congress did enact a new Medicare drug benefit. It's not effective yet, but it will be in a couple of years. So that may be of assistance to him as well.

WHITFIELD: Trudy, do you have any suggestions for Jeanetta?

LIEBERMAN: Yes, he should also look at his state. There may be a pharmaceutical assistance program that he qualifies for in his state. The state insurance department should be able to tell him whether that's the case. But many states have such programs that offer reduced price drugs to their residents.

WHITFIELD: All right. Seventy-one million American working-age adults apparently have a problem paying off their medical bills and paying off medical debt. Those are the kinds of numbers that we're dealing with right now. And Debbi, in Texas, is on Medicare, but apparently, she's having a problem still being able to afford care. Debbi, what's your question?

CALLER: I just have a question about, like, me. Like, I'm on Medicare, and I can't afford to go to the doctor. I can't afford my prescriptions. I have chronic pancreatitis, and I just don't know what to do.

WHITFIELD: And Trudy, she certainly isn't alone. It's pretty alarming. We're talking about millions of Americans who are in the same boat.

LIEBERMAN: Well, I wonder if Debbi has a Medicare supplement policy, because Medicare supplement policies -- and sometimes, they're called Medigap policies, they go by that name as well -- will cover the 20 percent coinsurance that people have to pay, as well as some of the deductibles.

That's the first place somebody should look to supplement Medicare's coverage. Also, if you live in a state that has a lot of HMOs, many HMOs also offer benefits to Medicare beneficiaries. And these HMOs have drug coverage along with them. So we often recommend that if you live in a place where there are a lot of HMOs, that's one of the first places you should look, because chances are, you can get some drug coverage. It might be only for generic drugs, but that might be better than nothing.

WHITFIELD: And Mila, would the same apply for someone who has partial or minimal medical care coverage. Might they be able to get some sort of supplemental care to help make ends meet?

KOFMAN: One of the things I would advise Debbi to do is look into a local community health center. These are free clinics where, sometimes, they provide care for a very small fee, and that's a very good option if there is one in your area. With respect to people who have limited private health benefits, if that's all you can afford, that should help a little bit by providing you with some protection. But it's certainly not going to prevent you from having financial problems.

I would stay away from limited benefit policies like cancer-only policies or hospital-only policies. I just think at the end of the day, by the time you pay the premium for all of those policies, you might as well get yourself a comprehensive package.

(CROSSTALK)

WHITFIELD: And the incentive on that for some people is that they feel like that's all they can afford. But then, lo and behold, it will cost them more in the long run, won't it? KOFMAN: That's exactly right, and it won't get them much coverage. There'll be substantial gaps in the type of coverage that they'll have, and they may not be able to access the doctors they'll need to, and they'll be stuck with huge medical bills.

WHITFIELD: John, in Louisiana, is on the telephone. And John, what's your question?

CALLER: Yes, I'm going to condense this as much as I can. I'm on SSI. I worked all my life on construction, seven days a week, 12 hours a day. Social security has come up with this program, they say, that you have to have so many quarters of work in order to qualify for full social security benefits.

I lacked one quarter, having that amount of time in. So they, therefore, put me on SSI. Now, would you like to explain to me, or is there anyone in the government, in any system, that can explain to me how we can afford to get any kind of insurance coverage or even eat on $545 a month?

WHITFIELD: Mila, you're nodding. Why don't you tackle that first?

KOFMAN: Well, I would call your senator and your member of Congress to let them know about your specific situation. They have the power to change the current laws. And if they hear from enough of you about your everyday, real struggles to survive, perhaps they'll do something about it.

WHITFIELD: And Trudy, sometimes it's rather overwhelming for people, especially when you're strapped with all these medical bills and you feel like you're really in a corner. You know, you feel powerless. Can it sometimes be as simple as going to your doctor and, perhaps, explaining your situation, or telling your medical care provider that, "You know what? Is there some sort of discount you can offer to me, or is there some sort of special, you know, incentive you can give me to continue coming here for my care, but maybe at a discounted price?"

LIEBERMAN: I think that's always an option for people. Some physicians may be very willing to do that for people who have serious financial problems, and others may not. One of the things that we found with doctors who are working in some of the community clinic networks is that they have been unwilling to donate free time for surgeries and so forth, for people who need to use those clinics.

However, I think we should always tell people that at least it's worth a try. And sometimes, the doctors also have free prescriptions that they can give you. Many of these are samples that the drug salesmen leave off. But for some families, they may have no other choice but to take them. And so, it's always worth asking about those.

And as well, the doctors can help people to fill out forms to qualify for pharmaceutical assistance programs that some of the drug companies have. Now, these are for people who have very low incomes, for the most part. But if you find yourself in that situation, it's worth asking about.

WHITFIELD: It's worth asking the questions to the doctors, or the nurses, or other healthcare providers. All right, Trudy Lieberman and Mila Kofman, hold on a moment. We're going to take a short break, and we'll continue take your emails and your phone calls. There's the number on your screen 1-800-807-2620, or email us at DollarSigns@CNN.com. We'll be right back.

(COMMERCIAL BREAK)

WHITFIELD: The number of Americans who are uninsured, at least temporarily, is growing, according to the Centers for Disease Control and Prevention. In 2003, 24.5 million working-age adults were uninsured for more than a year. That figure shows an increase of more than 2.6 million people.

And it also explains why 50 percent of personal bankruptcy cases are medical bill-related. We're talking about how to maximize any kind of medical or health insurance benefits and how to get help if you are in debt. Mila Kofman of Georgetown University's Health Policy Institute is joining us, as well as Trudy Lieberman of Consumers Union.

All right, ladies, an email from Julian, Ann Arbor, Michigan. And she writes, "My husband and I own a consulting business. We had to give up our health insurance when the monthly premium reached $800. We have been trying to find insurance again and were turned down because of past health problems." What resources are available to us, Trudy?

LIEBERMAN: The price of health insurance in the individual market is very, very high, so I'm not surprised at that amount of premium that they have to pay. One thing they can do is look to see whether their state has a risk pool. That might be an option for them. It's a place of last resort. It works sort of like automobile insurance risk pools.

But be forewarned that the prices could be very high in those arrangements as well.

WHITFIELD: And Mila, often, you see these kinds of premiums associated with something, say, like Cobra, when people are in between jobs and they really have very high premiums in which to continue some sort of healthcare coverage. Even with those figures, do you still encourage people to maintain or take Cobra just so that they have some sort of safety net, even if it's expensive?

KOFMAN: Oh, absolutely. Even an $800 a month, let's say, premium, is better than having a $10,000 hospital bill if you have to go to the emergency room because you broke your arm -- you fell and broke your arm. Absolutely, health insurance, especially good health insurance, is really important. Without that medical card, very few doctors will see you, and certainly, you don't want to tomorrow, get sick, and lose your house, lose your life savings over not having health insurance. I do want to add to Trudy's point that she made earlier. When you're stuck buying an individual health insurance policy or being in the individual market, it's very difficult to find health insurance. Insurance companies do not have to sell you a policy. That's called guaranteed issue. And the requirement to sell you the policy is only in effect in about five states or so.

WHITFIELD: So what do you do? What are your options?

KOFMAN: Well, you can still try to get an insurance policy. There might be a company that will sell you a policy, but you have to be prepared to pay a higher price. They'll surcharge you for existing or past medical conditions. Also, you have to be prepared for that insurance policy not to cover your existing conditions.

They may exclude them for a period of time or, actually, for as long as you maintain that policy. So just be prepared for those kinds of challenges. For the Michigan caller, I would say, if they can afford to hire an employee and become a small business, then their options increase substantially in terms of the kinds of coverage that's available to them. So if that's an option, I think that would be a good alternative for them.

WHITFIELD: And I wonder if, say, Julie and her husband, who emailed that question, or even others, do you have much leverage to try and negotiate a premium that is a little bit more manageable for you when you're dealing with these healthcare provider companies? You're shaking your head, no, Mila -- no negotiating power.

KOFMAN: No. The consumer is really powerless in the individual market. There's no negotiation. And watch out. Make sure that you pick the insurance that's good, because if you're not satisfied and you have existing medical conditions, or even medical claims, you're going to have a tough time switching insurance companies.

WHITFIELD: Wow.

KOFMAN: It's not like buying a car.

WHITFIELD: OK.

LIEBERMAN: I want to...

WHITFIELD: Trudy, hold that thought. In fact, we'll go ahead and let you express that thought on the other side of the break. And we'll be right back.

(COMMERCIAL BREAK)

WHITFIELD: On Dollar Signs, we're talking about healthcare insurance. How do you afford it? How do you get it? And how do you keep it? Mila Kofman of Georgetown University Health Policy Institute is joining us, along with Trudy Lieberman of Consumers Union. And Trudy, just before break, you were going to comment about what people who work for themselves should do about trying to maintain or get the right kind of medical coverage. LIEBERMAN: Well, the point I wanted to make is that people who have to go into the individual market when they leave a job really do need to take that Cobra coverage. We talked about it earlier. But they need to take it for the 18 months that it's available and pay the premiums, even though it's high. Because eventually, having exhausted that coverage qualifies you for a guaranteed issue policy.

And if you get sick or have any health conditions, that's a really important thing. So that's the most important takeaway.

WHITFIELD: OK. All right, Natalie, in California, is on the line, and she's got a problem with Medigap -- Natalie.

CALLER: Yes. I'm on social security disability, receiving $743 a month. For the first two years, I was on disability. I maintained a Cobra insurance at $475 a month. I am presently, finally, on Medicare, but did not take the Medicare. I chose to take an HMO here in California.

The HMO gets the $66, or whatever it is, from social security. But what they cover, compared to the regular policy on the Cobra, is about one-third. I would like to know why the insurance on the HMO doesn't pay for any of the items that I was already receiving on previous insurance, especially now, the fact that my income has gone down.

WHITFIELD: All right, Mila, why don't you tackle that.

KOFMAN: I think that's a great example of buyer beware. You have to read your coverage options very carefully and determine ahead of time whether or not that option will be adequate to protect you and take care of your medical needs. Consumers sometimes do have options. And as this caller demonstrates, what she's chosen is just not adequate.

But a broader point here is that lots of people have that problem. The basic problem is that we have almost 20,000 people who die every year because they don't have good medical coverage. We have people who have to declare bankruptcy because they don't have adequate coverage or don't have health insurance.

WHITFIELD: OK.

KOFMAN: It costs our economy billions of dollars each year...

WHITFIELD: So what should she do?

KOFMAN: Well, what we need to do, what policymakers need to do is come up with real solutions, so people like Debbi, so people like your caller from California don't have these problems.

WHITFIELD: Yeah. OK, I want to get in at least one other email -- this one coming from Greg, in Idaho. I'm a healthy, non-smoking, 31-year-old graduate student, living in Idaho. I have been without health insurance for the last six months. Any particular Web site or company that specializes in low-cost insurance for college students -- Trudy?

LIEBERMAN: This person should not have too much trouble getting insurance, particularly since he's healthy. One of the things we recommend at Consumer Reports is that you start looking at the local Blue Cross/Blue Shield plans in your area. What we found was that they often have very good options for people in these situations.

WHITFIELD: OK, all right. Well, Mila, sorry to cut you off a little bit earlier, but we only have a couple more seconds left. But thanks very much to both of you -- Mila Kofman, Georgetown University Health Policy Institute and Trudy Lieberman of Consumers Union. Thanks very much for helping us to understand how to maximize the opportunities to get health coverage out there.

That's all we have time for right now. Headlines when we come right back.

(COMMERCIAL BREAK)

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Aired July 17, 2004 - 16:30   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
FREDRICKA WHITFIELD, CNN ANCHOR: I'm Fredricka Whitfield. DOLLAR SIGNS is coming up next. But first, now in the news. Marion Jones pulls out of the 200 meters in the Olympic trials. She didn't say why. Jones is expected to hold a news conference in about 30 minutes.
American Lance Armstrong continues rolling toward a possible six Tour de France wins. Today, he clinched the 13th stage, closing within 22 seconds of the overall leaders. The race ends next Wednesday in Paris.

Well, welcome to DOLLAR SIGNS, where we help you get the most for your money. Today's topic is health insurance. Do you have enough, and do you have the right kind? With so many different health plans out there, my guests are going to help you sort through what's best for you.

Mila Kofman is an assistant research professor at Georgetown University's Health Policy Institute in Washington, and Trudy Lieberman is the director of the Center for Consumer Health Choices at the Consumers Union in New York. Good to see both of you, ladies.

MILA KOFMAN, GEORGETOWN UNIVERSITY: Thank you.

TRUDY LIEBERMAN, CONSUMERS UNION: Thank you.

WHITFIELD: Well, medical debt is huge in this country. And we decided now is a good time to help offer people some ideas as to how to tackle their medical debt, how to get out of it, and then how to choose the right medical policies, especially for those who are unemployed or, perhaps, who are working for themselves.

So let's begin with, you know, one scenario. Let's talk about, perhaps, the individual or the family. They don't have medical insurance, but they do have medical needs. Mila, what is that person or that family's options?

KOFMAN: First of all, they should go to our Web site, which is HealthInsuranceInfo.net. We have a consumer guide on health insurance for each state, including the District of Columbia. That's the best way to learn about the options that they may have.

Second of all, that family or that individual should remember, when they're thinking about comprehensive health insurance, it does two things for them -- a good policy, that is. One, it will give them access to medical doctors, to hospitals when they need medical care, and also, it will give them financial security. So when they get sick or they come down with a chronic disease, it won't mean that they'll lose everything, their life savings, their house, everything. So those are the things that I would keep in mind when shopping around for health insurance.

WHITFIELD: All right. We want to continue to urge people to send their email questions as well as call in. We've got our first caller on the line, Trudy. Her name is Jeanetta, in Utah, and she's got a question about insurance for the elderly -- Jeanetta. All right, it looks like we're having a problem with that phone line. So we'll try to return to that in a moment.

Well, Trudy, let me ask you then. There are a number of families who, perhaps, don't have insurance. They have medical needs, but they have accumulated quite a bit of medical debt. What do you recommend for that family or individual who has collected quite a bit of debt, but they still have some medical needs in which to get attended to?

LIEBERMAN: Well, the problem that they may have is being able to afford a policy. If people have to go into what we call the individual market to buy health insurance, they're going to find very, very high premiums. When Consumer Reports looked at the individual market a couple of years ago, we found that some policies for family coverage were as high as $16,000 a year.

Some of them, of course, were lower, but they were still in the $8,000 to $10,000 range. So a family with medical debt is going to be adding considerable amounts of money to their debt burden already.

WHITFIELD: All right. Jeanetta, in Utah, appears to be back on the phone with us and has a question about insurance for the elderly -- Jeanetta.

CALLER: Thanks for taking my call. My father is 82-years-old, World War II veteran, and unable to receive adequate healthcare and prescription medication at a reasonable amount of money. And so, I'm just so worried that he, being a World War II veteran, can't find health insurance life insurance, any of the World War II veterans, what happens to people like him and other people that may not be on veterans' benefits?

WHITFIELD: Mila, why don't you tackle that first?

KOFMAN: First of all, he should contact his local VA to see if there are any programs he may qualify for. Sometimes the local VA hospital will provide for prescription drugs that he may need. So that may help him out. Also, I don't know if he's on Medicare, but Congress did enact a new Medicare drug benefit. It's not effective yet, but it will be in a couple of years. So that may be of assistance to him as well.

WHITFIELD: Trudy, do you have any suggestions for Jeanetta?

LIEBERMAN: Yes, he should also look at his state. There may be a pharmaceutical assistance program that he qualifies for in his state. The state insurance department should be able to tell him whether that's the case. But many states have such programs that offer reduced price drugs to their residents.

WHITFIELD: All right. Seventy-one million American working-age adults apparently have a problem paying off their medical bills and paying off medical debt. Those are the kinds of numbers that we're dealing with right now. And Debbi, in Texas, is on Medicare, but apparently, she's having a problem still being able to afford care. Debbi, what's your question?

CALLER: I just have a question about, like, me. Like, I'm on Medicare, and I can't afford to go to the doctor. I can't afford my prescriptions. I have chronic pancreatitis, and I just don't know what to do.

WHITFIELD: And Trudy, she certainly isn't alone. It's pretty alarming. We're talking about millions of Americans who are in the same boat.

LIEBERMAN: Well, I wonder if Debbi has a Medicare supplement policy, because Medicare supplement policies -- and sometimes, they're called Medigap policies, they go by that name as well -- will cover the 20 percent coinsurance that people have to pay, as well as some of the deductibles.

That's the first place somebody should look to supplement Medicare's coverage. Also, if you live in a state that has a lot of HMOs, many HMOs also offer benefits to Medicare beneficiaries. And these HMOs have drug coverage along with them. So we often recommend that if you live in a place where there are a lot of HMOs, that's one of the first places you should look, because chances are, you can get some drug coverage. It might be only for generic drugs, but that might be better than nothing.

WHITFIELD: And Mila, would the same apply for someone who has partial or minimal medical care coverage. Might they be able to get some sort of supplemental care to help make ends meet?

KOFMAN: One of the things I would advise Debbi to do is look into a local community health center. These are free clinics where, sometimes, they provide care for a very small fee, and that's a very good option if there is one in your area. With respect to people who have limited private health benefits, if that's all you can afford, that should help a little bit by providing you with some protection. But it's certainly not going to prevent you from having financial problems.

I would stay away from limited benefit policies like cancer-only policies or hospital-only policies. I just think at the end of the day, by the time you pay the premium for all of those policies, you might as well get yourself a comprehensive package.

(CROSSTALK)

WHITFIELD: And the incentive on that for some people is that they feel like that's all they can afford. But then, lo and behold, it will cost them more in the long run, won't it? KOFMAN: That's exactly right, and it won't get them much coverage. There'll be substantial gaps in the type of coverage that they'll have, and they may not be able to access the doctors they'll need to, and they'll be stuck with huge medical bills.

WHITFIELD: John, in Louisiana, is on the telephone. And John, what's your question?

CALLER: Yes, I'm going to condense this as much as I can. I'm on SSI. I worked all my life on construction, seven days a week, 12 hours a day. Social security has come up with this program, they say, that you have to have so many quarters of work in order to qualify for full social security benefits.

I lacked one quarter, having that amount of time in. So they, therefore, put me on SSI. Now, would you like to explain to me, or is there anyone in the government, in any system, that can explain to me how we can afford to get any kind of insurance coverage or even eat on $545 a month?

WHITFIELD: Mila, you're nodding. Why don't you tackle that first?

KOFMAN: Well, I would call your senator and your member of Congress to let them know about your specific situation. They have the power to change the current laws. And if they hear from enough of you about your everyday, real struggles to survive, perhaps they'll do something about it.

WHITFIELD: And Trudy, sometimes it's rather overwhelming for people, especially when you're strapped with all these medical bills and you feel like you're really in a corner. You know, you feel powerless. Can it sometimes be as simple as going to your doctor and, perhaps, explaining your situation, or telling your medical care provider that, "You know what? Is there some sort of discount you can offer to me, or is there some sort of special, you know, incentive you can give me to continue coming here for my care, but maybe at a discounted price?"

LIEBERMAN: I think that's always an option for people. Some physicians may be very willing to do that for people who have serious financial problems, and others may not. One of the things that we found with doctors who are working in some of the community clinic networks is that they have been unwilling to donate free time for surgeries and so forth, for people who need to use those clinics.

However, I think we should always tell people that at least it's worth a try. And sometimes, the doctors also have free prescriptions that they can give you. Many of these are samples that the drug salesmen leave off. But for some families, they may have no other choice but to take them. And so, it's always worth asking about those.

And as well, the doctors can help people to fill out forms to qualify for pharmaceutical assistance programs that some of the drug companies have. Now, these are for people who have very low incomes, for the most part. But if you find yourself in that situation, it's worth asking about.

WHITFIELD: It's worth asking the questions to the doctors, or the nurses, or other healthcare providers. All right, Trudy Lieberman and Mila Kofman, hold on a moment. We're going to take a short break, and we'll continue take your emails and your phone calls. There's the number on your screen 1-800-807-2620, or email us at DollarSigns@CNN.com. We'll be right back.

(COMMERCIAL BREAK)

WHITFIELD: The number of Americans who are uninsured, at least temporarily, is growing, according to the Centers for Disease Control and Prevention. In 2003, 24.5 million working-age adults were uninsured for more than a year. That figure shows an increase of more than 2.6 million people.

And it also explains why 50 percent of personal bankruptcy cases are medical bill-related. We're talking about how to maximize any kind of medical or health insurance benefits and how to get help if you are in debt. Mila Kofman of Georgetown University's Health Policy Institute is joining us, as well as Trudy Lieberman of Consumers Union.

All right, ladies, an email from Julian, Ann Arbor, Michigan. And she writes, "My husband and I own a consulting business. We had to give up our health insurance when the monthly premium reached $800. We have been trying to find insurance again and were turned down because of past health problems." What resources are available to us, Trudy?

LIEBERMAN: The price of health insurance in the individual market is very, very high, so I'm not surprised at that amount of premium that they have to pay. One thing they can do is look to see whether their state has a risk pool. That might be an option for them. It's a place of last resort. It works sort of like automobile insurance risk pools.

But be forewarned that the prices could be very high in those arrangements as well.

WHITFIELD: And Mila, often, you see these kinds of premiums associated with something, say, like Cobra, when people are in between jobs and they really have very high premiums in which to continue some sort of healthcare coverage. Even with those figures, do you still encourage people to maintain or take Cobra just so that they have some sort of safety net, even if it's expensive?

KOFMAN: Oh, absolutely. Even an $800 a month, let's say, premium, is better than having a $10,000 hospital bill if you have to go to the emergency room because you broke your arm -- you fell and broke your arm. Absolutely, health insurance, especially good health insurance, is really important. Without that medical card, very few doctors will see you, and certainly, you don't want to tomorrow, get sick, and lose your house, lose your life savings over not having health insurance. I do want to add to Trudy's point that she made earlier. When you're stuck buying an individual health insurance policy or being in the individual market, it's very difficult to find health insurance. Insurance companies do not have to sell you a policy. That's called guaranteed issue. And the requirement to sell you the policy is only in effect in about five states or so.

WHITFIELD: So what do you do? What are your options?

KOFMAN: Well, you can still try to get an insurance policy. There might be a company that will sell you a policy, but you have to be prepared to pay a higher price. They'll surcharge you for existing or past medical conditions. Also, you have to be prepared for that insurance policy not to cover your existing conditions.

They may exclude them for a period of time or, actually, for as long as you maintain that policy. So just be prepared for those kinds of challenges. For the Michigan caller, I would say, if they can afford to hire an employee and become a small business, then their options increase substantially in terms of the kinds of coverage that's available to them. So if that's an option, I think that would be a good alternative for them.

WHITFIELD: And I wonder if, say, Julie and her husband, who emailed that question, or even others, do you have much leverage to try and negotiate a premium that is a little bit more manageable for you when you're dealing with these healthcare provider companies? You're shaking your head, no, Mila -- no negotiating power.

KOFMAN: No. The consumer is really powerless in the individual market. There's no negotiation. And watch out. Make sure that you pick the insurance that's good, because if you're not satisfied and you have existing medical conditions, or even medical claims, you're going to have a tough time switching insurance companies.

WHITFIELD: Wow.

KOFMAN: It's not like buying a car.

WHITFIELD: OK.

LIEBERMAN: I want to...

WHITFIELD: Trudy, hold that thought. In fact, we'll go ahead and let you express that thought on the other side of the break. And we'll be right back.

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WHITFIELD: On Dollar Signs, we're talking about healthcare insurance. How do you afford it? How do you get it? And how do you keep it? Mila Kofman of Georgetown University Health Policy Institute is joining us, along with Trudy Lieberman of Consumers Union. And Trudy, just before break, you were going to comment about what people who work for themselves should do about trying to maintain or get the right kind of medical coverage. LIEBERMAN: Well, the point I wanted to make is that people who have to go into the individual market when they leave a job really do need to take that Cobra coverage. We talked about it earlier. But they need to take it for the 18 months that it's available and pay the premiums, even though it's high. Because eventually, having exhausted that coverage qualifies you for a guaranteed issue policy.

And if you get sick or have any health conditions, that's a really important thing. So that's the most important takeaway.

WHITFIELD: OK. All right, Natalie, in California, is on the line, and she's got a problem with Medigap -- Natalie.

CALLER: Yes. I'm on social security disability, receiving $743 a month. For the first two years, I was on disability. I maintained a Cobra insurance at $475 a month. I am presently, finally, on Medicare, but did not take the Medicare. I chose to take an HMO here in California.

The HMO gets the $66, or whatever it is, from social security. But what they cover, compared to the regular policy on the Cobra, is about one-third. I would like to know why the insurance on the HMO doesn't pay for any of the items that I was already receiving on previous insurance, especially now, the fact that my income has gone down.

WHITFIELD: All right, Mila, why don't you tackle that.

KOFMAN: I think that's a great example of buyer beware. You have to read your coverage options very carefully and determine ahead of time whether or not that option will be adequate to protect you and take care of your medical needs. Consumers sometimes do have options. And as this caller demonstrates, what she's chosen is just not adequate.

But a broader point here is that lots of people have that problem. The basic problem is that we have almost 20,000 people who die every year because they don't have good medical coverage. We have people who have to declare bankruptcy because they don't have adequate coverage or don't have health insurance.

WHITFIELD: OK.

KOFMAN: It costs our economy billions of dollars each year...

WHITFIELD: So what should she do?

KOFMAN: Well, what we need to do, what policymakers need to do is come up with real solutions, so people like Debbi, so people like your caller from California don't have these problems.

WHITFIELD: Yeah. OK, I want to get in at least one other email -- this one coming from Greg, in Idaho. I'm a healthy, non-smoking, 31-year-old graduate student, living in Idaho. I have been without health insurance for the last six months. Any particular Web site or company that specializes in low-cost insurance for college students -- Trudy?

LIEBERMAN: This person should not have too much trouble getting insurance, particularly since he's healthy. One of the things we recommend at Consumer Reports is that you start looking at the local Blue Cross/Blue Shield plans in your area. What we found was that they often have very good options for people in these situations.

WHITFIELD: OK, all right. Well, Mila, sorry to cut you off a little bit earlier, but we only have a couple more seconds left. But thanks very much to both of you -- Mila Kofman, Georgetown University Health Policy Institute and Trudy Lieberman of Consumers Union. Thanks very much for helping us to understand how to maximize the opportunities to get health coverage out there.

That's all we have time for right now. Headlines when we come right back.

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