Having adequate, affordable medical insurance is essential because it ensures access to quality healthcare and helps pay for the high cost of medical services and supplies, surgery and hospitalization. You and your dependents may be eligible for one or more of the following medical insurance options:
Medical insurance for young adults less than age 26
Under the new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), effective September 2010, young adults covered under their parent’s medical insurance are eligible to remain covered up to age 26. The young adult is not required to live with their parents to be eligible and can even be married. Previously, most young adults “aged off” their parent’s medical insurance when they turned 19 or graduated from college. Find more details regarding medical insurance for adults less than age 26 by visiting our healthcare reform blog.
Guaranteed health insurance for children less than age 19
Also under PPACA, effective September 2010, health insurers and medical insurance 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 that excluded pre existing health conditions from being covered. For more information about guaranteed health insurance for children less than age 19, visit our healthcare reform blog.
COBRA continuation coverage
Passed by Congress in 1985, the Consolidated Omnibus Budget Reconciliation Act 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 policy due to pre existing health conditions. For COBRA eligibility rules and other details, visit our research center.
For individuals currently covered under an employer (group) health insurance plan that are leaving the employer, it might be possible to convert the job-based health insurance plan to an individual medical insurance plan. This is called “conversion” coverage. It is not the same as COBRA continuation coverage because benefits are usually reduced or limited. Contact your employer for information.
The Health Insurance Portability and Accountability Act (HIPAA) guarantees the right to purchase private major medical insurance to “HIPPA eligible individuals,” regardless of health status. HIPAA also prohibits health insurance companies from excluding pre existing conditions under the medical insurance plan. This is important because most private health insurance is currently medically underwritten (except for children less than age 19). Consequently, individuals 18 and older with medical conditions may not qualify.
A “HIPAA Eligible Individual” is someone who has/ is:
- 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,
- 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),
- Elected and exhausted COBRA continuation coverage, if eligible (employers less than 20 employees are not subject to COBRA),
- Not be eligible for coverage under another group health plan, Medicare or Medicaid, and
- Not currently covered under a medical insurance plan
“HIPAA eligible individuals” may purchase individual medical insurance directly from health insurance companies or their state’s High Risk Pool. These plans are required to offer individual medical insurance regardless of a person’s health status. For more details regarding HIPAA visit our research center.
Medicaid offers healthcare coverage to certain people with limited income that meet their state’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 our Government Plans section for links to your state’s health insurance programs.
State Children’s Health Insurance Plan
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 medical 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 medical insurance that pays for doctor visits, dental care, prescription medicines and hospitalization. Please visit our Government Plans section for the link to your state’s Childrens Health Insurance Plan.
Pre-Existing Condition Insurance and High Risk Pool Plans (PCIP)
The PCIP is a new program offered in every state under the new healthcare law. It is administered by either states or the Federal government. The Pre Existing Conditions Insurance Plan may help if you are unable to qualify for individual major medical insurance and meet the following qualifications:
- Uninsured for at least six months
- Have a pre-existing medical condition(s), and
- Have been denied coverage (or offered insurance without coverage of the pre existing condition) by a private health insurance company.
The PCIP covers major medical and prescription drug expenses. You are responsible for paying the premium, deductible, copayments, and coinsurance amounts. The PCIP will not cost you more just because of your health condition. Unlike Medicaid, eligibility for the PCIP is not based on income.
Guaranteed Health Insurance
Guaranteed Health Insurance, also called Mini-Med, Limited Benefit or Pre-Existing Condition Medical Insurance is another option if you are unable to qualify for individual major medical insurance. Since most Guaranteed Health Insurance Plans are not medically underwritten 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.
Individuals purchase Guaranteed Health Insurance because they:
- Cannot qualify or afford individual major medical insurance
- Want an ID card to gain access to the healthcare system in the event that unexpected medical care is needed
- Want to save money on healthcare expenses by paying reduced fees negotiated by the medical plan (discounts with participating healthcare providers can range from 10 to 25% and eliminate balance billing- owing the healthcare provider the difference between their retail charge and the rate negotiated by the preferred provider network)
At healthinsuranceadvisory.org, we believe a more informed consumer makes better decisions. That is why we empower our customers with better tools and information. Get an online health insurance quote and start saving today!