In the United States today, roughly 15 million Americans are covered under an individual medical health insurance plan. If you have tried to secure health insurance from the individual marketplace, then you know how challenging it can be. If you are healthy, getting approved is relatively straightforward once you get past the lengthy application process. It is not uncommon for medical insurance companies to ask detailed questions about your health history, height/weight, tobacco status and even occupation. In some instances, medical records are requested to help evaluate one’s health status. In others, a paramedical exam can also be required.
But, what if a pre existing condition is preventing you or a loved one from qualifying for an individual medical insurance plan? There are other health insurance choices. You have alternatives that perhaps you did not realize.
The following health insurance choices are the more common alternatives selected by individuals with pre existing health conditions:
Guaranteed health insurance for children less than age 19….
Effective September 2010 under the new health care law, called the Affordable Care Act, health insurance companies must offer 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 policy to limit coverage for pre existing health conditions.
Young adults less than age 26….
Also under the new healthcare law, effective September 2010, young adults covered under their parent’s medical insurance plan are eligible to remain covered up to age 26, regardless of marital, employment, student or financial status. Previously, most young adults “aged off” their parent’s medical insurance plan when they turned 19 or graduated from college.
COBRA Continuation Coverage….
Passed by Congress in 1985, the Consolidated Omnibus Budget Reconciliation Act requires the option to continue health insurance 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. COBRA Continuation Coverage must be made available for 18, 29, or 36 months. Although generally expensive, COBRA Continuation Coverage can be an excellent alternative for individuals who cannot obtain an individual medical health insurance plan due to a pre existing health condition.
HIPAA Portability Coverage….
The Health Insurance Portability and Accountability Act (HIPAA) guarantees the right to purchase an individual medical health insurance plan to “HIPPA eligible individuals,” regardless of health status. HIPAA also prohibits health insurance companies from excluding pre existing conditions under the individual medical insurance plan. This is important because most private health insurance is currently medically underwritten (except for children less than age 19 as indicated above). 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 health 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.
Conversion Policy under Employer Sponsored Group Health Plan….
For persons currently covered under an employer sponsored group health plan that are leaving the employer, it might be possible to convert the job-based health insurance plan to individual medical health insurance. This is called “conversion” coverage. It is not the same as COBRA Continuation Coverage because benefits are usually reduced or limited. For more information contact your employer.
Medicaid offers health insurance 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.
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.
Health Insurance for Pre Existing Conditions….
Guaranteed Health Insurance also referred to as Mini-Med or Limited Benefit, is another option to secure health insurance if you have a pre existing condition. Since most Guaranteed Health Insurance Plans are not medically underwritten your acceptance is guaranteed. While considered supplemental health 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)
Government Pre Existing Conditions Insurance Plan (PCIP)….
The government Pre Existing Conditions Insurance Plan is a new program offered in every state to individuals that would otherwise not qualify for an individual medical insurance plan. Enacted as part of the new healthcare law, it is administered by either states or the Federal government. You may be eligible for the PCIP if you meet the following qualifications:
- Have not had qualified medical insurance for at least six months
- Have a pre existing medical condition, and
- Have been denied coverage (or offered insurance without coverage for the pre existing condition) by a private health insurance company.
The government Pre Existing Conditions Insurance Plan is low cost medical insurance that covers medical and prescription drug expenses. You are responsible for paying the premium, deductible, copayments, and coinsurance amounts.
For questions, contact us today. Our goal is to help consumers research, identify and learn their health insurance choices, regardless of health status.