Health Insurance: Frequently asked questions

Jun. 30, 2006

I was just diagnosed with diabetes. My employer doesn't offer health insurance, but I want to buy it on my own so I am covered for my illness. What can I do?

You might not have many options.

The fundamental premise of health insurance is that you should have it before you actually need to take advantage of it. When you go shop around for a health plan now, your diabetes will be considered a "pre-existing condition" — because it began before you had insurance.

Insurance companies don't like selling plans to people who are already sick, because it's a surefire bet that you will spend more of their money than someone who is healthy.

You can still shop around for individual coverage, though. Insure.com has a story on buying individual insurance that is chock-full of tips. Your state insurance department can also provide some help and give you a list of companies licensed to do business in your state.

There is a federal law called the Health Insurance Portability and Accountability Act (HIPAA) that provides some protection against exclusions for pre-existing conditions for people entering a new health plan if they meet certain qualifications. The broadest protections, however, are for employees who move from one group health plan to another group plan (generally when they change jobs). Individuals looking for individual coverage have less protection.

One of the (many) conditions for your HIPAA eligibility is having been covered under a group health plan for the most recent period you had health insurance, even if that coverage was just for one day. You, unfortunately, had no coverage at all, so that immediately disqualifies you. If you had met all the requirements and were HIPAA eligible, an individual plan would have been forced to cover your diabetes.

Don't despair yet, though. Many states offer health plans through what are called "high-risk pools" for people like you who might not be able to get insurance on the open market. Because the people in those pools typically have more health problems, the premiums for those plans are higher. But having insurance through a high-risk pool is a far better cry than having none at all when you are sick. Read more on High-risk health insurance pools.

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