Health Insurance Coverage for Pre-existing Conditions

It is difficult, but not impossible to obtain health insurance coverage for pre-existing conditions. A pre-existing condition is defined as a medical condition for which a person has received treatment prior to enrolling in his or her current health insurance plan. The timeframe for this treatment is determined by the individual health insurance carrier, and in some cases can include a condition the patient is aware of, but has not treated.

Insurance companies often offer health insurance coverage for pre-existing conditions that include either a waiting period or an exclusion clause. When a person with a pre-existing condition applies for health insurance, the carrier may include a clause that makes him responsible for the cost of treating his pre-existing condition for a certain period of time or excludes treatment for this condition from his policy altogether.

Individual Health Insurance Coverage for Pre-existing Conditions

• Group health insurance coverage for pre-existing conditions is more accessible, but if this is not a possibility, there are other options:

  • Basic Health Insurance: A health insurance plan that covers a limited number of medical expenses. These plans are available in most states. They accept enrollees under the age of seventy, and pay for pre-existing conditions after six months.
  • COBRA: Available to those leaving a qualifying group plan in order to bridge the gap between health insurance coverage.
  • Public Assistance Plans: Health insurance plans available to individuals with a limited income. For information, contact the Department of Social Services.
  • High Risk Pools: Every state has a health insurance plan that accepts those who are not eligible for any other type of coverage. To qualify, applicants must have had health insurance for eighteen months or complete a waiting period before pre-existing coverage takes effect. To find out what individual states offer, visit www.MedSave.com for links to the various state insurance bureaus.

HIPAA and Health Insurance Coverage for Pre-existing Conditions

People seeking health insurance coverage for pre-existing conditions have found some relief in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPPA is designed to make it easier to secure and maintain continuous health insurance when changing jobs; lessens the likelihood of losing existing coverage; and helps working individuals who lose group benefits to retain coverage on their own. It does this by:

•  Limiting the use of pre-existing condition exclusions.

•  Prohibiting group plans from denying coverage or charging higher premiums based on the past or present health status of a potential policyholder or members of his family.

•  Guaranteeing small business owners and individuals who lose employee sponsored health insurance the right to purchase coverage.

•  Guaranteeing that small business owners and individuals, who purchase health insurance can, in most cases, renew coverage regardless of health status.

For the HIPAA eligibility requirements and more information on health insurance coverage for pre-existing conditions, visit www.cms.hhs.gov/hipaa .

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