Mass. Health Plan May Be Inadquate for Young Adults, Study Says

Massachusetts’ new low-cost health insurance coverage for young adults doesn’t work for the seriously ill, a long-standing problem with a similar program for college students, according to a new study.

The plans, designed for people age 19 to 26, are modeled on coverage that many Massachusetts college students have had to purchase since 1989. Those plans include annual limits on coverage for each illness, as well as caps on outpatient care and surgeons’ fees that have left some students with enormous bills, according to a report by the Access Project, a Boston-based health advocacy and research group.

The new young adult plans contain some protections not included in the student plans, but most cap annual coverage at $50,000 or $100,000 to keep premiums low.

“These folks will often buy based on price alone,” said Stephen D’Amato, an insurance consultant and one author of the report. “But the main purpose of insurance is to protect people in those rare instances when you have huge costs. Allowing these caps is duplicating a mistake that was made nearly 20 years ago. It’s going to destroy some lives.”

The report suggests that the state overhaul the student plans and eliminate the coverage limits in the new young adult plans.

State officials say that both plans are designed to balance affordability and coverage for what is typically a healthy population.

Young adults represent the largest segment of the uninsured in Massachusetts — about 75,000 ages 19 to 24.

The Legislature, worried that many would continue to resist buying insurance, decided to offer special plans for them as part of health care reform.

Premiums for the young adult plans start as low as $119 a month without drug coverage for people in greater Boston. The young adult plans are available only to people who are not offered insurance through their employer.

Access Project noted that Blue Cross Blue Shield is offering a low-cost young adult plan without any dollar limits.

The report also suggests that students with low incomes should be allowed into the state’s subsidized insurance programs.

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Information from: The Boston