Health Insurance for Pre-existing Conditions

[Updated Feb. 19, 2013]

If you're healthy, health insurance is an expensive annoyance. You know you should have it, but it seems like a waste of money. And millions of Americans go without health insurance, because they don't want to be expensively annoyed. But if they get sick or are injured while uninsured, they learn the hard way that, even more than a loan, health insurance is hard to get when you really need it. That's why you should always have health insurance, especially if you're in good health (when it's much easier to get).

Once you become sick or are injured, you have a pre-existing condition. From the perspective of a health insurer, that very possibly makes you a losing proposition. No one likes losing propositions, and certainly not insurance companies, whose business is, in essence, to bet on the health of their customers. Very few people today contract leprosy, but a lot of people who have a pre-existing condition and are uninsured learn what it feels like to be a leper.

So how can you protect yourself?

Get health insurance while you're healthy. The best way to cover pre-existing conditions is to be insured at the time they first occur. It's now illegal for insurance companies to drop coverage for customers who get sick or are injured. Axing customers who might actually make claims is prohibited by the federal health insurance reform enacted last year (derisively called Obamacare, but it really does help those who are sick or injured).

Keep your current health insurance. If you are covered by health insurance, keep it. That would mean exercising your COBRA rights if your employment is terminated. As your COBRA coverage expires (usually after 18 months), buy an individual policy to continue coverage. Avoid time gaps in coverage--continuous coverage one way or another makes it essentially impossible for insurers to stiff you on pre-existing conditions.

Be young. Last year's health insurance reform law now makes it illegal for insurers to decline coverage for children under the age of 19 due to pre-existing conditions. In addition, young adults up to age 26 may be covered under their parents' health insurance (if their parents have family coverage).

Be old. If you're 65 or older, make sure you're enrolled in Medicare (at least Parts A and B, and also Part D if you don't otherwise have prescription medication insurance). Pre-existing conditions are covered by Medicare.

State pools. Many states have insurance pools that offer coverage for their residents with pre-existing conditions. These pools can be expensive. But being uninsured with a pre-existing condition can be more expensive.

Federal High Risk Pool. A federal program created by last year's health insurance reform provides coverage to those who are uninsured with pre-existing conditions. This program isn't cheap, but is less expensive than many state pools. (A problem for those in state pools who want to switch to the lower cost federal program is that you have to be uninsured for something like six months before you can get into the federal program; that's because the federal program is meant to help the uninsured, not the expensively insured.) The federal high risk pool expires in 2014, when a permanent program for comprehensive nationwide health insurance coverage is supposed to begin. The website for the federal high risk program is at www.pcip.gov.  Feb. 19, 2013 update:  the federal high risk pool is  closing on Feb. 22, 2013 because of funding problems.  If you want to participate, get your application in by Feb. 22, 2013.  If you miss this deadline, look for any available state insurance pool, find out if you're eligible for Medicaid (see below), try a community health center, and wait until 2014, when comprehensive insurance coverage under the Affordable Care Act will become available.

2014. If you live until 2014, a comprehensive nationwide program for health insurance coverage will begin, which will prohibit health insurers from excluding pre-existing conditions.  Insurance for those who otherwise aren't covered can be purchased through so-called health insurance exchanges.  Your home state may offer an exchange (possibly in conjunction with other states), and a federal exchange will be available if your state does not offer one.

And if you're broke? If your financial condition is sufficient modest, you may qualify for Medicaid (it's primarily for people with dependent children or a disability). You might also be able to get care at a community health center (which generally serve the low income). And there's always the hospital emergency room, which provides care to the indigent (although it may not be as comprehensive as the care provided to the insured).

For more information, see http://blogger.uncleleosden.com/2010/04/benefits-of-federal-health-insurance.html, and http://blogger.uncleleosden.com/2007/06/how-to-find-health-insurance.html. The U.S. Department of Health & Human Services provides a website where you can research health insurance options: http://www.healthcare.gov/.