Options for the People Denied Health Insurance
When an insurance company is deciding whether or not to insure you, they conduct a risk analysis. If you’re healthy and young, your risk of costing them a lot of money in claims is going to be low, so you have to pay less for your policy. If you’re older and have a few medical problems, you’ll be a higher risk and will pay more in premiums. However, sometimes the risk analysis says a person is so high risk they would be a financial liability to the company and should not be covered at all.
People all over the United States have been denied health insurance coverage. Denials usually occur because someone has serious health problems, such as a history of cancer or maybe a compromised immune system. But what options do these individuals have in this situation? The answer in some states is the high risk insurance pool.
High Risk Insurance Pool
In a number of states, the high risk insurance pool was created to provide a safety net for people who were turned down for coverage. Individuals in the pool must pay premiums but the premiums are often limited to keep them at least somewhat affordable. However, they are going to be higher than average because the people in the pool are likely to need more health care than average.
To qualify, you usually need to have been turned down at least once for health insurance. Generally, if you’ve received one refusal for coverage, that means most companies are not going to cover you no matter how many times you apply.
Even in the high risk insurance pool, you’ll have some of exclusions for pre-existing conditions and you’ll be expected to pay co-insurance, pay a deductible, and make co-payments for your health care. The only difference between the high risk pool and traditional health insurance is that nearly anyone can be accepted into the pool.
Another Option
While high risk insurance pools are an option in many states, they are not available in all 50 of them. In some cases, you may have other options. For example, if you have health problems and employer-provided coverage but lose your job, you might be able to prevent the loss of your coverage.
Under HIPAA, a Federal health law created to protect workers from losing their health coverage just because they lost their employment, you can participate in COBRA. Under COBRA, you can continue paying premiums for the coverage provided through your employer for up to 18 months. Now the premiums will be higher because your ex-employer no longer has to subsidize them, but you cannot be refused this coverage.
When you try to get new insurance — individual or group plans — you will be considered to have maintained consistent coverage thanks to COBRA so you won’t be turned away nor will you necessarily have to worry about pre-existing condition exclusions. You’ll receive credit for the amount of time you have been insured.
Although both COBRA and high risk health insurance are expensive, they are more affordable than the medical bills you could incur by having no coverage whatsoever.
June 18, 2009, Posted by Rainy Day Mitch