Call your state's Insurance Department for assistance.
Most insurers consider those with serious pre-existing conditions, such as diabetes, HIV, heart disease, cancer and autoimmune diseases, as high-risk. However, those with less serious pre-existing conditions, such as allergies, high-blood pressure and moderate obesity, are usually not high-risk. Licensed health insurance agents can identify high-risk persons by consulting the insurer's medical underwriting guide and/or speaking with the insurer. Unlike the general population, health insurance for high-risk people is often expensive, exclusionary and/or incomprehensive.
Significance
Health insurance, like other forms of insurance, is based on risk. The less risky a candidate is, the more insurers want her business. Hence, insurance companies offer the cheapest and most comprehensive plans to the healthiest applicants. The process by which insurers review medical records and determine a candidate's risk is called medical underwriting. Although medical underwriting is illegal in a few states, most states allow it. While medical underwriting keeps costs down for the general pool by avoiding adverse selection, it is also partly responsible for the high number of uninsured Americans.
Non-Exclusionary Plans
Most high-risk insurance plans are exclusionary, which means that the insurer will not cover treatments for the pre-existing condition for at least six months---sometimes longer. However, a popular non-exclusionary plan is COBRA (Consolidated Omnibus Budget Reconciliation Act). People who lose their jobs for any reason other than gross misconduct are eligible for COBRA if they apply within 62 days. Unlike other plans, COBRA cannot deny applicants due to pre-existing conditions or impose riders. A group plan is another non-exclusionary plan. Unlike individual plans, group plans do not discriminate based on pre-existing conditions. Those eligible for group insurance usually get it through their or their spouse's employer, but some states allow an individual to become a "group of one."
Exclusionary Plans
Some individual insurers will take a high-risk person depending on the seriousness of her pre-existing condition and her general health. Aetna, in particular, is famous for having the most liberal medical underwriting policy for individual insurees. Furthermore, in many states, the insurer must take the applicant if she has had continuous coverage. However, almost all individual insurers impose waiting periods of at least six months before covering treatments related to the pre-existing condition. State high-risk pools are available to those who cannot get individual coverage. As of March 2010, 35 states have high-risk pools.
Costs
Unless part of a group plan, high-risk insurance premiums are expensive. Therefore, most high-risk people are insured through their or their spouse's employer since group plans cannot discriminate and since the employer pays half the costs. When people lose their jobs, they usually opt for COBRA. But since the employer no longer pays half, COBRA can cost over $400 per month. The monthly premiums for state high-risk pools usually start at $300 and can exceed $1,000, even with a high deductible. Individual high-risk premiums through companies, such as United and Anthem, can also exceed $1,000 per month.
Alternatives
Many high-risk people, particularly those who are self-employed and cannot get individual coverage, pay out of pocket. The government lets them deduct medical costs that exceed 7.5 percent of their annual income from their taxes. Some high-risk people opt for a medical discount plan while others use a limited, catastrophic plan. Although discount and catastrophic plans are incomprehensive, some high-risk insurees still find them beneficial.
Tags: medical underwriting, high-risk people, pre-existing conditions, high-risk pools, pre-existing condition, cannot individual, cannot individual coverage
