Pre-existing conditions make it difficult to find health insurance but it is still possible. There are companies that will write policies as well as state and federally funded programs that can help. You may have higher premiums or a waiting period before a health insurance company will cover your pre-existing health condition.
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Pre-existing conditions are classified as any medical condition you were diagnosed with, treated for or treatments were recommended for prior to applying for health insurance. The Health Insurance Portability and Accountability Act allows group policies to only look at the last six months of your medical records. This can include conditions that were diagnosed while you had coverage through another company if there is a lapse in coverage over 63 days.
What state and federal programs provide health insurance for pre-existing coverage?
Every state is required to offer some type of health insurance pool for people with pre-existing conditions. The pool can either be state funded or funded by the federal government.
National Association of State Comprehensive Health Insurance Plans was established in 1993 to help states set up and run their pools. Each state has their own regulations for qualification.
Medicaid and Medicare will also cover pre-existing conditions if you meet the qualifications for eligibility. Medicaid is a federally funded program to help individuals and families that have income levels below the poverty level. Medicare is designed to provide health insurance for people over the age of 65 or who are permanently disabled and on Social Security.
The Affordable Care Act that was passed in 2010 included provisions for health care insurance for pre-existing conditions. As of 2010, health insurance companies can no longer deny coverage for children that have pre-existing conditions. In 2014, health insurance companies will not be able to write exclusions or deny coverage on new policies for anyone with a pre-existing condition.
Can I get private insurance if I have a pre-existing condition?
Private health insurance may be difficult to obtain depending on what your preexisting condition is. If your employer offers a group insurance plan, it may be a better option. They guarantee approval but may still have exclusions for the pre-existing condition.
If you do find a company that will write you a policy there may be limits to the care you can receive. Many times they will require a six month to one year waiting period. This means you can receive care for any new health issues or preventive care covered by the plan. They will not pay for any treatments that are a result of your pre-existing health conditions.
Health insurance companies may also charge you higher premiums. Pre-existing conditions mean you are at higher risk for utilizing coverage under your policy. Health insurance companies are in the business to make money and by charging higher premiums they can offset the cost of your care.
A study by the Kaiser Family Foundation showed that health insurance premiums for people with preexisting conditions ranged from between $2000 and $30,000 a year. They used eight hypothetical applicants and submitted 60 applications for each one. Pre-existing conditions ranged from mild hay fever to HIV. All of the HIV applications were rejected and 8% of the hay fever.
How can I avoid a lapse in coverage that results in a pre-existing condition?
If you have health insurance when you are diagnosed avoiding a lapse in coverage will prevent insurance companies from denying you coverage. The Health Insurance Portability and Accountability Act provides you protection when changing jobs.
As long as you are not without health insurance for more than 63 days the new health insurance company must cover you. One option you may have is Cobra insurance. Cobra is a federally mandated program for companies with more than 20 employees.
Cobra allows you to retain your health insurance for 18 months after you are separated from your job. This includes coverage for your family if your plan covered them as well. You will be required to pay 102% of the premiums but it is creditable insurance to avoid pre-existing condition penalties.
Remember, your group policy premiums are usually paid partially by your employer. Cobra costs can be much higher than you are used to paying. The extra 2% is used to pay administrative fees.
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