Jonas Weisel has gotten used to the letter he receives at the end of each year telling him his health insurance premium will go up again the next year. But this year's increase of 69 percent stopped him cold.

"Shocked doesn't quite cover it," said Weisel, 54, of Santa Rosa about his reaction to learning the premium he and his wife pay for individual coverage at Kaiser Permanente will go from $564 per month to $955 on Jan. 1.

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He said he has experienced increases of 22 and 25 percent for the past two years.

For the less than 10 percent of people who have individual health care coverage and pay for the entire premium, this can be a tough time of year. While Weisel's increase is higher than average, people in individual and group plans are all getting hit with rate hikes.

Employers, who are responsible for covering the vast majority of insured Americans, have been wrestling with double-digit premium increases during the past three years. But recent surveys show they have been able to keep costs from skyrocketing this year by shifting some of the burden onto their employees in the form of heavier cost sharing and higher co-payments.

But people with individual coverage, often those who are self-employed or unemployed or who for some other reason cannot get health care through an employer, have to shoulder the entire increase.

For Weisel, who has asthma, and his wife, who also has asthma and an intestinal condition called Crohn's disease, getting another form of coverage may not be easy because of their health conditions.

"We're looking at alternatives, but until we find something else, we're not going to leave," he said of Kaiser, where he has been a satisfied member since 1987. He said he was offered his plan without prescription drug coverage, but that would still account for a 58 percent increase over last year.

Pete Andrade, vice president of small business and individual plans for Kaiser, said Weisel's increase is not typical of most individual plan increases, which averaged about 13 percent for 2004.

Weisel is part of a relatively small percentage of Kaiser's 350,000 individual plan members who are on a conversion plan, which is a plan for people who have pre-existing conditions and do not qualify for the more- popular lower-cost plans. Andrade said premium increases for members on conversion plans will be about 20 percent next year.

Andrade said those people tend to be sicker and to use the system more, so their increases are greater. "We don't think it's fair that everyone else picks up that cost," he said. "We don't subsidize the conversion plan by charging everyone more,'' he said.

Andrade added that the benefits for those plans will remain the same or become even more comprehensive and that increases in the higher age ranges may be more extreme than for younger members.

Peggy McPhee, a Kaiser member on a conversion plan, said her coverage will increase 63 percent -- to $490 per month from $300. McPhee also happens to be from Santa Rosa, but Kaiser officials said the increase is not geographical in nature.

"I can't afford this," said McPhee, 51, who makes $18,000 a year and whose employer does not provide health insurance. She said that with her two health conditions, it's unlikely that she will find other, more affordable coverage.

Kaiser isn't the only insurer raising rates. Health Net of California plans to increase rates in February for its 4 percent of members on individual plans but doesn't expect those increases to average more than the high single digits. Blue Shield officials said rate hikes affecting individual plans will average in the low to middle teens next year.

Jane Powell, a Berkeley resident and member of Blue Cross of California, just found out her monthly premium will go up to $733 a month from $575 -- an increase of more than 27 percent.

Blue Cross spokeswoman Kellie Bernell declined to comment on any rate changes for individual members, saying that the increases vary and affect members at different times of the year depending on their plan.

Powell's situation is a little different because she was part of the state's Major Risk Medical Insurance Program, a plan for people who are completely uninsurable. The 51-year-old Powell, a survivor of non-Hodgkin's lymphoma who has suffered from two other chronic illnesses, felt fortunate to be insured.

But after the program developed a long waiting list, the state changed the rules and moved people off the state program with the guarantee of receiving similar coverage from a private insurer for only a slightly higher initial rate. So Powell still has coverage but is planning to refinance her home to reduce her mortgage payments in order to pay for the premium increase.

"I know there are many people who have no insurance at all, and there are those who might think me lucky to have it at all," said Powell, a freelance writer. "But I don't feel lucky -- a quarter of my income down a rathole which supposedly might keep me from having to declare bankruptcy should I actually get sick or be in a car accident."


Source: San Francisco Chronicle