For anyone with a pre-existing condition, our health care system may seem backwards. Because of your condition, you probably need more healthcare than most people but currently, there’s a big chance that it will be very expensive for your or you get denied coverage altogether. This can be frustration and for many millions of American who have had to live with pre-existing conditions for many years, you can feel like a slave to your health insurance. One of the only ways people with pre-existing conditions can find affordable insurance is to maintain employer coverage. This puts many people in a dire situation if they lose their jobs or feel stuck in a bad work situation. Soon, this will be changing. With the passage of the Affordable Care Act (ACA), charging extra or denying coverage of health insurance for pre-existing conditions will be outlawed. Until then, try your best to maintain the coverage you have but if that’s not possible, here are few options that may be able to get through the remaining months of 2013.
What is a Pre-Existing Condition?
Before we get into the details of health insurance though, it’s important to examine exactly what is a pre-existing condition and how does it affect your health insurance. Officially, a pre-existing condition is considered to be a medical condition that you had before your health benefits took place (if you were approved that is). Health insurance companies, knowing that you’re going to cost more money than someone who is healthy, will either charge you more to offset the costs expended by them or deny you coverage at all. In a report issued by the U.S. Health and Human Services department, up to 129 million non-elderly U.S. citizens have a pre-existing condition and without the ACA implementation, almost 50% could be denied coverage. Luckily, many people won’t have to worry about that anymore.
HHS Secretary Kathleen Sebelius said, “The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions. The new law is already helping to free American from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”
Examples of pre-existing conditions common medical diagnoses like asthma, high blood pressure, arthritis, and cancer. Sometimes, pregnancy has been considered a pre-existing condition. But if you need health insurance right now, you have several options but hopefully you’ve been saving up to pay for them.
Your Options: Health Insurance for Pre-Existing Conditions
If you have employer sponsored insurance but you’re just itching to quit your job, try to wait it out until you have other coverage. If you feel like you have to quit or don’t have a choice and get laid off, you can still obtain insurance through COBRA, which doesn’t discriminate against pre-existing conditions. Set up in the mid 1980’s, this bill allows individuals to maintain their employer sponsored insurance for a certain amount of time after your employment has ended. Even if you quit, you can choose to select COBRA insurance but just be aware that while you maintain exactly the same benefits you had before, you now pay the full premium.
The advantage to an employer sponsored plan is that many times, they foot the majority of the bill. With COBRA, you pay the full amount and that can range from $200 per month to over $1000 depending on what kind of coverage you have. You can elect to change certain aspects of your policy to save money but unfortunately, many people don’t elect COBRA coverage because of the high cost. This can come back to bite you though because currently, some insurance companies consider you to be a higher risk if you’ve been without insurance for a certain amount of time. This is because it’s likely you didn’t go to the doctor at all so when you finally get coverage, you could find out that you have cancer, which the insurance company then has to pay for.
If you are purchasing individual insurance, it can be difficult to find. Unless your pre-existing condition is very severe the likelihood of you being denied coverage is slim but you are going to pay more or have limited benefits that might not even cover the main reason why you need health insurance. You may have a CSD, or condition specific deductible added to your policy. This means that in addition to your normal deductible, your pre-existing condition will have a completely separate deductible and may have a coverage limit. In all reality, it’s not a terrible compromise. The insurance company knows that their costs won’t go over a certain amount for your specific condition and you’re well aware of the out of pocket costs associated with the condition. If you can cover that balance, you’re okay but if you go over your coverage limit, that’s when you get into trouble. If anything, it’s better than complete denial of any coverage but you still have to assess your individual situation to see if the deductibles and limits make financial sense.
Be sure to check your state options as well. Many have what is known as ‘insurers of last resort’ and they will insure you regardless of your medical history. It’s likely that will be expensive and it has time limitations on it as well. You can’t have gone a certain amount of time without insurance or else you won’t be able to qualify. Other states may have high risk pools which also provide insurance coverage for those who can’t normally qualify for insurance (we’re talking to you pre-existing condition!). Again, this is going to be an expensive option but it’s better than no coverage at all, especially if your condition requires consistent medical attention.
Originally, the federal government had set up the Pre-existing Condition Insurance Plan to provide coverage for those who hadn’t had health insurance for a certain amount of time. It was going to stand in until the 2014 clause took effect, prohibiting pre-existing condition discrimination, but that program was utilized by so many that it is now suspended until further notice. This happened in February.
What The Future Brings
Luckily, the many American citizens with pre-existing conditions will only have to tolerate extremely high premiums or no insurance coverage for the rest of 2013. 2014 is right around the corner and with, big changes are coming. Those that already have group insurance probably won’t see a big change in the type of coverage they have as well as the premiums that pay but those that have had a hard time getting insured will see a world of difference. You may find that you receive better benefits and through state healthcare exchanges, you will be able to compare policies to find one that suits your personal needs. Best of all, it’s supposed to be more affordable for everyone.
Right now, it can be frustrating to find health insurance for pre-existing conditions but not taking care of your health is a surefire way to become worse. Don’t let cost deter you from coverage the last few months of this year. Change is coming and you will need to be healthy to get a running start.