Medical Insurance Options – Alabama « Health Insurance Advisory

Medical Insurance Options – Alabama

Author: Administrator | Feb 20 2011 | Alabama
 Medical Insurance Options   Alabama

Alabama - Find Medical Insurance

Having adequate, affordable medical insurance is essential because it helps ensure access to quality healthcare and helps pay for the high cost of medical services, supplies, surgery and hospitalization. But, what if you are unable to secure individual major medical insurance because of a pre-existing condition? You and your dependents may be eligible for one or more of the following alternatives in Alabama:

Medical Insurance for Adults Less than Age 26 – Alabama

Under the new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), starting as early as September 2010, young adults covered under a parent’s medical insurance policy in Alabama are eligible to remain covered up to age 26. Previously, most young adults “aged off” their parent’s health insurance when they turned 19 or graduated from college. The young adult is not required to live with his/ her parents to be eligible and can even be married. Even if you have already “aged off,” special enrollment opportunities may apply. Additional details regarding medical coverage for adults less than age 26 can be found in our healthcare reform blog.

Guaranteed Health Insurance for Children Less than Age 19 – Alabama

Also under PPACA, starting as early as September 2010, medical insurance companies and health plans must provide coverage to children less than age 19, regardless of their health status. Previously, all applicants regardless of age could be denied individual medical insurance or have restrictions put on their medical insurance (Exclusionary Endorsements or Elimination Riders) that have the effect of excluding existing health conditions from being covered under the policy. For more information regarding guaranteed health insurance for children less than age 19, visit our healthcare reform blog.

COBRA Continuation Coverage – Alabama

The Consolidated Omnibus Budget Reconciliation Act was passed by Congress in 1985 and requires health insurance continuation coverage be offered to employees, their spouses, their former spouses and their dependent children when group health coverage would otherwise be lost due to specific events. Continuation coverage must be made available for 18, 29, or 36 months. Although generally expensive, COBRA can be an excellent alternative for individuals who cannot obtain an individual or self-employed medical insurance coverage. For COBRA eligibility rules and other details, visit our research center.

Conversion Policy

If you are currently covered under an employer (group) health insurance plan and are leaving your employer, you might be able to convert your job-based health insurance plan to an individual medical insurance policy. This is called “conversion” coverage. It is not the same COBRA continuation coverage because benefits are usually reduced or limited. Contact your employer or employer (group) health insurance carrier for information.

Health Insurance Portability and Accountability Act (HIPAA) Coverage – Alabama

HIPAA guarantees the right to purchase private major medical insurance to HIPPA eligible individuals, regardless of their health status. HIPAA also prohibits medical insurance companies from excluding or restricting coverage for pre-existing conditions. This is important because most private health insurance is medically underwritten. Consequently, individuals with medical conditions may not qualify. The new healthcare reform law, however, as indicated above prohibits children less than age 19 from being declined medical insurance coverage. Medical insurance companies may still ask for a child’s health history, but coverage cannot be declined or restricted in any way. Pre-existing conditions must be covered.

A “HIPAA Eligible Individual” is someone who has/ is:

  1. Had continuous (no break in coverage for 63 days or longer) credible medical insurance coverage for at least eighteen months with the most recent coverage being under a group health plan,
  2. Lost group coverage due to circumstances other than fraud or non-payment of premium (whether you quit your job, were fired or laid off does not matter),
  3. Elected and exhausted COBRA continuation coverage, if eligible (employers less than 20 employees are not subject to COBRA),
  4. Not be eligible for coverage under another group health plan, Medicare or Medicaid, and
  5. Not currently covered under a medical insurance plan

In Alabama, “HIPAA eligible individuals” may purchase individual medical insurance directly from Alabama’s High Risk Pool. The state’s High Risk Pool is required to offer individual medical insurance regardless of a person’s health status.  For more details regarding HIPAA visit our research center.

Medicaid – Alabama

Medicaid offers healthcare coverage to certain people with limited income that meet Alabama’s Medicaid eligibility requirements. Generally, children and parents, pregnant women, people with disabilities, and seniors are included. Medicaid programs are run by states with a mix of state and federal funding. There are certain core rules all states must follow, but some Medicaid rules vary by state.

Since most states are currently facing severe budget deficits, Medicaid eligibility rules and benefits provided under the program may have recently changed. Please visit Alabama’s Medicaid program for current information and details.

State Children’s Health Insurance Plan – Alabama

If you are seeking health insurance for your children, President Obama signed the Children’s Health Insurance Bill on February 4, 2009. It enables millions of children to receive health insurance. The eligibility rules for the Children’s Health Insurance Plan are unique because every state has its own program and rules. Generally, uninsured children 18 years old and younger whose families earn up to $44,500 a year (for a family of four) are eligible for free or low-cost health insurance that pays for doctor visits, dental care, prescription medicines and hospitalization.

Since most states are currently facing severe budget deficits, eligibility rules and benefits provided under Alabama’s Childrens Health Insurance Plan may have recently changed. Please visit Alabama’s State Childrens Health Insurance Plan for current information and details.

Pre-Existing Condition Insurance and High Risk Pool Plans (PCIP) – Alabama

The PCIP is a new program offered in every state under the new healthcare law. It can be administered by either states or the Federal government. The PCIP may be able to help you if are unable to qualify for individual major medical insurance. You may qualify for Alabama’s PCIP if you have been:

  1. Uninsured for at least six months
  2. Have a pre-existing medical condition(s), and
  3. Have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private health insurance company.

PCIP covers major-medical and prescription drug expenses. You’re responsible for paying premium, deductible, copayments, and coinsurance amounts. PCIP will not cost you more just because of your health condition. PCIP is not based on income eligibility like Medicaid.

Visit Alabama’s PCIP for more details.

Guaranteed Health Insurance

Guaranteed Health Insurance, also called Mini-Meds, Limited Benefit Plans, Guaranteed Acceptance Plans and Pre-Existing Condition Medical Insurance, is another alternative for health insurance if you are unable to qualify for individual major medical insurance. Most Guaranteed Health Insurance Plans are not medically underwritten, so acceptance is guaranteed.

While considered supplemental medical insurance, not major medical insurance, these plans typically pay a fixed dollar amount for covered healthcare expenses, such as physician office visits, diagnostic services, lab, x-ray, surgery, inpatient confinement and wellness. The dollar amount the policy will pay is significantly less than individual medical insurance.

Individuals purchase Guaranteed Health Insurance for many reasons, such as they:

  • Can’t afford or qualify for individual major medical insurance,
  • Save money on healthcare expenses by not paying retail (discounts with participating healthcare providers can range from 10 to 25% and eliminate balance billing, thereby guaranteeing you will not owe your healthcare provider the difference between their retail charge and the rates negotiated by the preferred provider network), and
  • Want an ID Card to gain access to the healthcare system in the event unexpected medical care is needed.
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