For people with pre-existing medical conditions, finding and keeping affordable health coverage can be a nightmare. In the best-case scenario, coverage is extended as a work-related benefit. Individuals with pre-existing conditions cannot be denied coverage under group insurance plans. Unfortunately, however, statistics show that 21 percent of those who apply for health coverage on their own each year are denied coverage or charged exorbitant rates because they do have some pre-existing medical issue.
One of the best ways to guarantee coverage is to become a business in your own right. In some states an individual business owner can qualify for a group plan, in others there must be two people involved in the company. That, however, can be as simple as employing your brother or cousin. Even in this scenario, be aware that insurers can deny coverage for pre-existing conditions for a brief period of time usually not exceeding six months, during which time expenses for the maintenance or treatment of the problem will come out of your own pocket.
Workers laid off from their jobs can qualify for COBRA coverage, which can get quite expensive. Presently, however, if you have lost your job since September 1, you are eligible for a 65 percent discount on COBRA premiums. Details of this program are available at the Department of Labor’s website. Additionally, laid off workers should apply for new insurance within 63 days of their termination. All states have what is called an “insurer of last resort,” a company that is required to take all applicants. Restrictions on what the insurer of last resort can charge vary by state, with details available at your state insurance commissioner’s website. (Another option is to investigate coverage available through professional organizations.)
Thirty-one states (Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin, Wyoming) maintain high-risk pools to cover people with pre-existing conditions who have exhausted all avenues and still been unable to find affordable coverage.
In extreme cases, generally those where a child has a long-term illness and faces termination of benefits under the parents insurance plan, relocation to an insurance-favorable state is an option. Residents in Maryland, Massachusetts, New Jersey, New York and Vermont cannot be denied insurance and limits are set on what insurers can charge and on what deductibles they can impose. Although an extreme suggestion, for families facing years of high medical costs, the option should not be ignored.
The high cost of individual health insurance is a burden on families with no medical problems, but for those with pre-existing conditions, the threat of losing health benefits is an ever-present danger. Until some form of national health care reform is enacted, the best option is still to receive health coverage as a benefit of your employment if at all possible.