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Ask the Health Insurance Expert

My girlfriend is in her early thirties and hasn't had health insurance for many years. She is suffering from chronic stomach pains and fears she might need surgery. It's getting to the point where she really needs to see a doctor and she might need a long list of tests done. What do you suggest as she buys health insurance for the first time?

Have your girlfriend check into her state's Pre-existing Condition Insurance Plan. The federal government has worked with states to set up these temporary high-risk insurance pools for people who need insurance now and can't otherwise qualify for it in the private market. The pools will operate until 2014 when insurers will no longer be able to deny coverage to applicants, such as your girlfriend, based on their health conditions.

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Many states have operated similar programs to uninsurable residents. The Pre-existing Condition Insurance Plans supplement, rather than replace, those existing high-risk pools. In some states, applicants can choose the program that would suit their needs best.

Under the new Pre-existing Condition Insurance Plans, coverage includes primary and specialty care, hospital care and prescription drugs -- including treatment for pre-existing conditions. To be eligible, applicants must have a pre-existing condition and must have gone without medical insurance for at least six months.

Go to the U.S. Department of Health and Human Services' website, which provides a helpful Pre-existing Condition Insurance Plan map. Pick your location, and the site will provide information on your state's program.

Note that some plans are administered by states, and others are administered by the federal government. Starting this year, enrollees in federally administered plans can choose between three options:

1.      Standard Plan

2.      Extended Plan

3.      Health Savings Account eligible plan

The plans feature different deductibles and premiums.

For more, see health insurance pools for people with pre-existing conditions.

Last updated: Mar. 11, 2011
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