Health Insurance | Pre-Existing Condition

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If you’re uninsured and sick, you may feel locked out of the health insurancemarket. While it’s true that it may seem impossible — or unaffordable — to buy health insurance when you have a “pre-existing condition,” there are practical ways you may be able to get coverage for yourself to ease the burden of medical bills.

Strategies for anyone who’s sick

1. Get a job with a group health plan
Granted, it’s not a piece of cake to go out and find a job that will offer you group health insurance, especially if your illness prevents you from working. But securing group coverage is sometimes your best shot at accessing affordable medical insurance. Once you become eligible for an employer’s group health plan, which may include sitting out a standard waiting period, you must be accepted into the plan with the same coverage as other employees; a group plan cannot exclude yourpre-existing conditions like an individual private-market plan could.

2. Have your spouse get a job with a group health plan
If it’s not feasible for you to get a job with group benefits, perhaps your spouse could. Then you could be added to the plan as a dependent. You’d still gain the benefits of group health rates and cannot be excluded because of pre-existing conditions.

3. Start a business
If working for someone else in order to gain group benefits isn’t your style, you may be able to achieve the same result by working for yourself. Some local Chambers of Commerce offer group health benefits to members. By starting a viable business and joining the Chamber, you may be able to buy into a Chamber group health plan.

4. Buy an individual plan on the private market
How, you are asking, could you possibly obtain coverage through a private-market health plan if you are already sick? While you aren’t likely to find a plan to cover your pre-existing condition, you may be able to find one for other medical visits. Health insurers may be willing to sell you a health plan that excludes your condition (called an “elimination rider”) but that would still cover treatment unrelated to your condition. This route, though not ideal, allows you to secure partial coverage.

5. Turn 65
Once you turn 65 and are eligible for Medicare, you will be covered. Medicare can’t exclude your pre-existing conditions from coverage.
Depends on your state

6. Buy a “guaranteed issue” plan
The following states require that health insurers offer all or some of their health plans to individuals regardless of pre-existing conditions: California, Idaho, Maine, Massachusetts, Michigan, New Jersey, New York, Ohio, Oreon, Rhose Island, Utah, Vermont, Washington and West Virgina, according to the Henry Kaiser Family Foundation (KFF). For more information about your state’s laws, visit statehealthfacts.org.

7. Be a “group of one”
Some states require that health insurers offer guaranteed issue group health plans to small groups. “Guaranteed issue” means that your group cannot be turned down, even if the group has unhealthy members.

Now here’s where you may be in luck: Some states mandate that those plans be offered to groups as small as one, such as self-employed individuals. That means that by creating your own “group of one,” you may have access to a group health plan. Laws vary by state and sometimes your “group” has only a small window each year to enroll. For example, in Florida, health insurers are required to offer guaranteed issue basic or standard plans to the self-employed during a one-month annual open enrollment period, according to KFF. To see whether your state has such a law, see KFF’s statehealthfacts.org.

8. Join the “high risk pool”
Most states offer a “high risk health insurance pool,” but you have to be eligible. Rules vary by state, but generally you must show that you’ve been turned down for an individual plan or offered only plans with “elimination riders” or very high premiums. High risk pools typically have waiting periods of six to 12 months before coverage kicks in, and some may have waiting lists.

Special Circumstances

9. For those with low incomes
All states administer a Medicaid program to provide health coverage to folks with low incomes. Rules vary by state. The Centers for Medicare & Medicaid Services has more information.

10. For parents with low incomes
You don’t always have to be a child to take advantage of coverage through your State Children’s Health Insurance Program (SCHIP), but you do have to meet low-income and other requirements. Some states have extended the boundaries of these programs by allowing parents of eligible children and pregnant women to join, too. Connecticut, for example, extends SCHIP to parents, relatives and caregivers of the eligible child in its HUSKY Plan.

To find out your state’s SCHIP rules, visit InsureKidsNow.gov.

11. For those facing job loss or divorce
The federal COBRA law may come to your rescue if you find yourself uninsured because of certain events, such as the loss of your job or the death of a spouse who held group health coverage. COBRA entitles you to continue to buy the group health plan (at your own expense) if you would otherwise lose group health coverage because of job loss, reduced hours at work, divorce, death of a spouse or other “qualifying events.” For more, read Know your COBRA rights.

A Slim Chance

12. Join an alumni or professional group
Occasionally an alumni or professional association will offer a group health plan to its members. This would allow you to obtain coverage no matter what your health. Robert Zirkelbach, spokesperson for America’s Health Insurance Plans, a trade group of health insurers, says these groups often don’t fare well because they tend to attract a high number of sick individuals who, as a sick group, push up the rates and ultimately cause the group to collapse.

While an individual within a group can’t be charged higher rates, a sicker group overall will be charged more than a healthier group. If your health insurance group is attracting a high proportion of people with lots of doctor bills, your premiums could go through the roof.

Michelle Megna

Contributor

Michelle, the former editorial director, insurance, at QuinStreet, is a writer, editor and expert on car insurance and personal finance. Prior to joining QuinStreet, she reported and edited articles on technology, lifestyle, education and government for magazines, websites and major newspapers, including the New York Daily News.

12 ways to get health insurance if you’re already sick

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