Health Insurance & Pre-Existing Conditions

Do you have a pre-existing medical condition? Have you been looking for insurance? Perhaps you've just moved from one job to another and are finally able to get health insurance through your employer, but you weren't previously insured and you've been under treatment for some health-related concern in this period.

At this point, it can be a tough process to find insurance once you've already proven that you need the insurance. After all, the risk you pose to the insurer has just gone up. Frankly, insurers prefer to insure people who are not likely to NEED the insurance.

The terms used in the health insurance industry for coverage that will take someone with a pre-existing condition are open enrolment plans and takeover benefit's. It helps to use these specific terms when shopping for health insurance to communicate clearly the type of coverage you are seeking. Keep in mind that most U.S. health plans do not offer these features. Also, these plans have different meanings within specific health plans and both do not always go together, especially when enrolling in a new health plan without prior coverage.

Although this type of health insurance is available to everyone who cares to go through the steps necessary to locate an appropriate plan, the price of this coverage can be two to three times the amount of health insurance that does not offer this coverage. While most of these procedures are governed by federal law known as HIPAA, the specific procedures vary significantly from state to state.

Having said that, generally for individuals not eligible for commercial health insurance plans, there are three categories of health insurance plans that offer open enrolment and takeover of pre-existing medical conditions:

  1. Basic Health Insurance: Basic health insurance is a limited coverage plan that is available in most states. It admit's all applicants under age 70 and pays for pre-existing medical conditions after being enrolled for six months. As the name implies, this insurance covers limited items and not all medical costs. If this would meet your needs, see your state page at for information about availability, rates and enrolment.
  2. COBRA plans: COBRA is a very specific plan that is available if you are leaving a qualifying group plan. It does not apply if you have had insurance individually. If COBRA coverage might apply to you, you should contact your sponsoring employer or your group health plan directly to access benefit's.
  3. Public assistance plans: While no one wants to go this route, it may provide you with the coverage you need. Obviously, these are available only if you have limited income and assets. Note that these plans will vary from community to community and change frequently. The easiest way to find the plans available in your area is to look in the blue pages of your local telephone book under the term "welfare office" and call to ask for more information.
  4. High-risk pools: High-risk pools provide still another avenue for insurance coverage. Each state has at least one plan that will accept individuals not eligible for coverage under other health plans. The "catch" is that the applican't must have maintained coverage for at least 18 previous months or satisfy a new waiting period before coverage becomes effective. In order to meet this requirement, many people use an inexpensive short-term health insurance to satisfy the waiting period and then switch to the assigned risk plan. The best way to find such plans is to telephone your state insurance department.

It takes at least a few weeks to enrol in this type of health insurance coverage. If you need immediate health insurance coverage, short-term medical plans issued online that do not offer takeover of pre-existing coverage might be necessary just to bridge the gap.

You can still save money, even if you are looking for open enrolment insurance:

  1. Use short-term health insurance during the required waiting period for most open enrolment plans. Under HIPAA law, the continuity of coverage rules then apply to the new insurance plan even though you were covered by a less expensive insurance policy during the waiting period. After the switch, your new plan will cover pre-existing conditions immediately.
  2. Put family members on different plans even if you need open enrolment insurance. The best health plan for one family member with medical insurance problems is usually not the best choice for others who don't have pre-existing medical conditions.
  3. "Basic Health Insurance" accepts all applicants and covers all pre-existing medical conditions after the policy has been in force for 6 months. This is a limited benefit plan that does not cover catastrophic costs and is not available in all states. You'll have to check with your state government to see if it is available in yours. While Basic Health Insurance won't cover everything, it also doesn't cost as much as other plans.
  4. If out-of-pocket cash medical costs are high, join a health care discount plan. This is not insurance, but does reduce your out-of-pocket expense.
  5. Be sure to check with the state insurance department for plans for applicants with lower income. You may qualify for better coverage at a lower cost.

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