Most health insurance will suit people just fine--until they get sick and really need it.

While most healthcare insurance clients say they are satisfied with their current plans, the landscape changes when major illnesses start.

Surveys by Consumer Reports, Information Strategies, Inc. (ISI), this newsletter's parent, and others indicate significant changes in attitude after a major illness.

When health plans are put under the microscope of usage, the complaints from consumers begin to pile up.

That is a key finding from a new Consumer Reports National Research Center survey that studied the experiences of more than 37,000 readers in health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

The survey found that among readers who were not seriously ill, complaints about gaining access to care at an HMO or PPO typically hovered in the single digits. But the complaints were nearly three times greater for those with a serious illness.

Readers' experiences were far worse if they were in HMOs that ranked toward the bottom in satisfaction. Overall, 9 percent said they had trouble getting care, but complaints grew to 21 percent in the lower-rated HMOs combined for those who were seriously ill. Even the best HMOs saw a spike in complaints.

With the approach of the annual open-enrollment period, when millions of people who obtain health-care insurance through their employer or through Medicare will have the chance to switch plans, the Ratings will help people find HMO or PPO (available to subscribers) coverage that might provide better care.

It's an option many people might want to exercise, the survey found. One out of five people were sufficiently disappointed with their health-insurance plans that they wanted to switch to a new one, according to the responses we received.

The major complaints included choice of doctors, billing issues, high out-of-pocket costs and access to care.

Consumer Reports found that people enrolled in the lowest-rated HMO or PPO plans in their Ratings were twice as likely to want to switch out of their current plans as people in the top-rated HMOs and PPOs.

Other research has found enormous differences in the level of care different plans provide, with patients in the best plans more likely to receive the kind of high-quality care that translates into better overall health.

One report found that if all health plans, HMO or PPO, provided the same disease-prevention programs, wellness plans, and best-practice treatments as the country's top 10 percent of health plans, as many as 81,000 deaths could be avoided each year.

Up to $3.6 billion in unnecessary hospitalization expenses also would be saved, according to the 2006 State of Health Care Quality report issued by the National Committee for Quality Assurance (NCQA), a nonprofit health-care research group.

To discern the best plans, every two years Consumer Reports asks their readers to rate their HMOs and PPOs. This year they present detailed information on 34 HMOs, plans that pay almost all expenses for patients who stick to providers within a network, and 46 PPOs, plans that cost more but allow more choice of doctors. These health plans are among the top 100 in the country in number of people covered.

ISI's surveys asked respondents to answer a critical question, "would they recommend their current plan to a family member or friend."

More than 80% said they would recommend an HSA, high deductible plan while only 54% would recommend a PPO or HMO.