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Massachusetts enticing young adults with low-cost insurance plans

BOSTON --Paul Bruns is your typical 26-year-old: athletic and ambitious. He's also uninsured.

"I definitely think about it when I'm thinking about skiing or snowboarding or doing something else crazy," said Bruns, who's been without health insurance for 10 months. "What would happen if my appendix burst, which is totally reasonable for a guy my age?"

When Massachusetts was crafting the landmark health care law that officially took effect on Sunday, much of the focus was on older residents who typically face larger insurance bills.

But those overseeing the law realized they were missing a key demographic -- young adults between the ages of 19 and 26, often in low-paying jobs and strapped with debt.

To entice those like Bruns, the Commonwealth Health Insurance Connector, the state agency overseeing the law, worked with private insurers to come up with young adult plans with monthly premiums as low as $106.

July 1 was the deadline for virtually everyone in the state to be insured, although there is a grace period until the end of the year. Anyone without insurance by Dec. 31 faces the loss of the $219 personal exemption when filing state taxes next year.

One of the toughest challenges is simply convincing younger people they need insurance.

"If you're young and healthy, it's not at the top of your mind," said Larry Levitt with the Kaiser Family Foundation, a California-based nonprofit health policy foundation. "Young people frankly don't think about catastrophic coverage and don't think about access to the system for routine coverage."

About 27 percent of Massachusetts residents ages 19 through 26 are uninsured, compared with 10 percent of the under-65 population as a whole, Levitt said, citing U.S. Census figures.

The young adult plans, from $106 to $220 per month, are available for anyone aged 19 through 26 who makes more than $30,630 annually, doesn't get health insurance through work or school, isn't still on a parent's plan, and isn't qualified for subsidized care.

They are being offered by the state's top insurers including Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Fallon Community Health Plan, Tufts Health and others.

"These are designed to be affordable," said Dick Powers, a spokesman for the Connector.

But even the low cost can be a burden on some young people, said John McDonough, executive director of Health Care for All.

"If you're living paycheck-to-paycheck, you're paying off student loans, paying rent, you're in a different situation from someone who isn't already burdened by debt," he said.

The problem isn't unique to Massachusetts.

There are about 13.7 million people in the 19-to-29 age bracket in the U.S. without insurance, according to the New York City-based Commonwealth Fund.

It's the fastest and largest segment of the uninsured population, said Sara Collins, Commonwealth Fund assistant vice president lead author of "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help."

"This age group does tend to be healthier than the population at large, and per capita spending on health care for this age group is about $1,500 per year," she said.

The Connector has tried to educate the 19-to-26 age bracket with a series of newspaper and television ads and opinion pieces submitted to college newspapers. One print ad featured a photo of a young woman bungee jumping off a bridge. The Connector also ran television ads during Red Sox games, hoping to reach roughly the same demographic.

Not everyone is convinced.

The young adult plans are similar to the Qualifying Student Health Insurance Program plans available to college students since 1988 -- more affordable but with low benefit maximums, high deductibles and high co-insurance pays.

"The young adult plans can have an annual benefit maximum as low as $50,000, and for anyone who gets seriously ill, or is involved in a serious accident, it's quite easy to go beyond that," said Carol Pryor, a senior policy analyst with The Access Project, a Boston-based health care resource center affiliated with Brandeis University.

With deductibles as high as $2,000, someone who may just see a doctor a couple times a year may not even see any benefit. And even if the deductible is reached, there can be a 20 percent co-insurance pay on hospital visits with some of the plans.

"They're not providing coverage for every day, and they're not providing coverage for catastrophic illness, either," she said.

Anyone who exceeds the annual maximums may find themselves deep in debt.

"Many of these young adult plans aren't real insurance," said Andrew Cohen, of The Access Project. "The real reason for insurance is to protect you from financial burden, and these plans don't do that."

Bruns, who is planning to begin working on contract next month building Web sites for Harvard University, said he'd be leery of any health plan with a cap on benefits.

"The whole point of health insurance is for those rare chances when something astronomical goes wrong," he said.

But Powers of the Connector said "less than one half of 1 percent of the population has medical bills that exceed $50,000 a year."

And, he said, young adults can opt for more comprehensive -- albeit considerably more expensive -- plans. One of the gold plans is more than $430 per month.

The eyes of the nation are on Massachusetts.

"Overall. It's quite path-breaking in its effort to get everyone coverage," Levitt said. "The rest of the country is going to be looking at it to see if it succeeds."


Associated Press writer Steve LeBlanc contributed to this report.


On the Web: Massachusetts Health Connector,

Commonwealth Fund,

Kaiser Family Foundation,

The Access Project,

Health Care For All,