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To offer a different perspective... I'm younger than you, and was shopping for individual insurance.

In my case, the hardest part was trying to compare plans from the companies in my area. All of them have slightly different ways of making it profitable for them. One could have Rx copays, but a special deductible for ER and urgent care visits. Another company may have only Rx reimbursement and office visit copays. So on and so forth. I actually had a spreadsheet with about a dozen columns to try to figure out, based on how I've used healthcare in the last few years, what plan is likely to be best for me.

Anything to simplify it would be great.

Moreover, the companies I've worked with on this, Blue Cross of Florida and United Healthcare (GoldenRule), in my own experience, the rates they quoted me online after filling out their survey were correct.

Healthcare costs and complexity surely go up as we all get older, so that, plus difference in state laws, probably explain the differences in value we see in this app.

I'm 34 now, but my last tussle with private insurance happened when I was 28.

Did you fill out complete applications for Blue Cross and United? Were you presented with a sign-on-the-dotted-line contract with a rate on it?

Were you applying solely for yourself?

Again, if you're in your 20s, healthy, male, and alone, you are very easy to insure, because you cost epsilon for Blue Cross to insure.

Yeah, I'm currently insured by United and was previously insured by Blue Cross.

I think your point is correct that the site is a (now cliched?) "leaky abstraction." But the good news is that it works for at least some segment of the market (those like myself).

I was 25 when I did the Blue Cross app and 27 when I did United.

This is a cool idea, and a good first start implementation. It's also the basis of the "Health Insurance Exchanges" that are due to be set up by the Affordable Care Act (a/k/a Obamacare in the pejorative).

Starting in 2014 individuals can buy insurance directly in an Affordable Insurance Exchange. An Exchange is intended to be a transparent and competitive insurance marketplace where individuals and small businesses can directly buy qualified health benefit plans.

It doesn't solve the immediate problem obviously, but the Federal timeline for implementation is here: http://www.healthcare.gov/law/timeline/index.html

Individual states are free to set up exchanges prior to the mandatory deadline, but with politics being what they are, that's not a guarantee of swift action. The details on implementation will be promulgated by Health and Human Services, most likely via the CFR and Federal Register, so we don't yet know how it will shake out in detail. But there's an overview PR-style here: http://www.healthcare.gov/news/blog/health_insurance_exchang...

> What would be very valuable would be a crowdsourced version of these charts.

Could not agree more with your post, and the item quoted above in particular.

(My own case: I'm as healthy as an ox, wife has inflammatory arthritis, which makes the application look like a book. When everything is done, you can be sure that we end up paying $JACKED_RATE*$MYSTERY_FACTOR.)

My daughter had what we're pretty sure was a drug reaction seizure when she was 4. Uninsurable.

You can also expect that any woman with any reproductive health issue, no matter how common, will be automatically declined for private health insurance, and will at best be able to obtain outrageously expensive last-resort insurance with a rider excluding huge swaths of her physiology.

But these sound like simple gripes about how broken our insurance system is. That's not my point. My point is that the rates you get on a website like this have no bearing on the rates you'll actually be contractually promised, unless you are a healthy male in your 20s.

I wonder if advertised rates like this are somehow based on average group coverage rates. It's completely whack, but, none of this stuff applies in group coverage. In group, you tell your provider "here's how many families, couples, and singles we have", and I think maybe the ages, and then you get a simple number for each category.

Would it be worth it, or even possible, to find a few other families in similar situations and create a dummy corporation which "employs" all of your families? All of you could collectively pay for a share of the group premiums -- ironically, I think this is similar to how health insurance was originally intended to function.

In CA at least, there are rules about a regular salary going to the insured employee.

That said: If you have a startup paying you regularly, I believe there are non-exclusionary laws preventing the insurance company from excluding employees which makes it a good avenue to pursue. I know folks that structured buyouts so that they would continued to be employed (and paid) by a shell company simply to maintain insurance.

> You can also expect that any woman with any reproductive health issue, no matter how common, will be automatically declined for private health insurance

Not so fast. If she never goes "bare", she can't be denied for pre-existing conditions.

Is it really that hard for people who know that they have chronic conditions to act as if they have chronic conditions?

What do you mean, "goes bare"? My family has had continuous coverage since I get married, and both me and my wife had continuous coverage prior to that. Are you trying to say it's impossible to be denied coverage? You're wrong.

I'm not going to get into the severity of the "chronic conditions" we're talking about because they're none of your business, but based on prevalence in the population, it's crazy that they're auto-decline conditions.

I'm not saying that it's impossible to be denied coverage; I'm saying that continuous coverage can make that a non-problem.

http://en.wikipedia.org/wiki/Health_Insurance_Portability_an...

> based on prevalence in the population, it's crazy that they're auto-decline conditions.

Are they "auto-decline" or "they can't charge expected costs"?

> I'm not going to get into the severity of the "chronic conditions" we're talking about because they're none of your business

No one asked you to, so why the attitude?

This is exactly the problem. Despite spending what is in my many cases billions of dollars a year on IT and related underwriting systems, most of the major health insurers in the US still have some manual touch involved in their pricing, which means that they can't price in anything near real-time. Even the best can do perhaps half in a fully automatic way, yet generally choose not to do it in realtime (for reasons I'll never fully grasp).

One major insurer that I'm familiar with receives applications from the biggest of these sites by fax, on paper. They're then shipped to a low cost country, where they're scanned, and then passed along to another low cost country to have the OCR corrected. Then the work comes back on-shore to be manually adjudicated. Figure 3 days minimum, a week on average to get all of this done.

A crowd-sourced solution would be astronomically useful. For it to be accurate, you need to capture a decent amount of medical information (most insurers ask a pretty standard set of ~20 questions), but even knowing that the average person pays 1.4x the quoted rate for someone of their age/gender/zip would be a great tool.

I've been in your shoes and I empathize. In fact, I was in your shoes just a few days ago when I applied for insurance. The rates here are "representative" and I tried to add disclaimers in the obvious places. The rates are similar to what you see if you check with your state's insurance commissioner. Most states require the health insurance companies to publicly disclose those rates.

Of course, they can still mess with you and they won't hesitate to do so if they think they can't make money at this price. There's no way to find out the final rate without completing the entire application process. In that respect it's similar to auto insurance.

PickHealthInsurance still has a lot of utility compared to existing sites, though.

You can get often get the advertised rates, but not always. In Washington State for example, you can get these rates if you're running out of COBRA and you've been covered continuously. They aren't allowed to ask questions.

I don't think there's a magic bullet, unfortunately. Suggestions welcome.

Are you sure Washington State is that simple? I don't live there and only spent a few moments researching, but I don't see that WA has guaranteed issue with continuous coverage. It does seem to have guaranteed renewal, but that locks you into one insurer, doesn't it?

Here we have something called the Standard Health Questionnaire (SHQ), which they make you fill out when applying for insurance. But there are a bunch of exceptions at the top which make it possible to avoid submitting the SHQ. Running out of COBRA is one of those exceptions.

This is exactly how it worked for me when my COBRA coverage expired and I lived in WA. Bypassing the SHQ was key to getting reasonable rates for myself.

Washington is actually pretty good relative to any other state I've seen. If you avoid SHQ through previous coverage, especially post-Obama changes (getting rid of lifetime limits), buying health insurance IS fairly straightforward.

Even with the SHQ, it seems deterministic.

Agree: great start on possible plans in the area, but the leg work is in filling out the application (that can be tedious/long if you have any medical history), obtaining a real quote, and then comparing the plan details.

Another leg work item is understanding the plan details. While it is great to see initial set of plans, it is hard to compare plans (how does United Health "Saver 80" compare to the IHC Group "Freedom HDHP"?). Possible feature enhancement: provide me a table compare of the details.

Lastly, many of the details of picking a plan for families centers around the current health ecosystem: Is our pediatrician participating in the plan, what is really covered, and what is the track record of the insurance company paying claims. That deeper information, if offered early, could help in the search for a plan.

I develop for a company that does much of this. Electronic applications, plan comparisons, drug rates, etc. Also, you can phone in and have someone help you through the process. Is this more of what you would like so see?

https://www.extendhealth.com/health-insurance/quote/search

Crowdsourcing health insurance is a really interesting idea.

Why shouldn't I, and many other people, open our medical records and insurance information? I.e. post it to some publicly accessible database, anonymously or not.

Could we get insurance providers to make us individuals/families offers, then, instead of us having to do the searching?

It may take some time before such a social/industrial shift occurs, if ever.

In the meantime, a bot that submits my info to various providers and gives me their actual quotes in sortable format could expedite choosing health care based on actual quotes, rather than the (usu. equal or lower) advertised rates.