Medical Insurance for People With Pre-Existing Conditions

Having a pre-existing medical condition and obtaining medical coverage can be a problem when an individual changes jobs, is self-employed or unemployed. Understanding the options and rights an individual has will help with obtaining coverage.

HIPAA

• The Health Insurance Portability and Accountability Act (HIPAA) protects individuals with pre-existing conditions from being excluded from employer policies. HIPAA limits how long a group plan can make one wait to start new coverage. HIPAA also protects against discrimination of dependent family members due to pre-existing conditions, genetic information or previous claims.

Group Plan

• A group plan is medical coverage received through an employer. An individual with a pre-exisitng medical condition cannot be denied coverage or be required to pay more for the premiums with a group plan.

Individual Plan

• An individual plan does not offer the same protection as a group plan. An insurance company can charge more for the premiums or choose to not offer coverage at all. However, if an individual had group coverage HIPAA offers protection by allowing an individual to purchase coverage through conversion plans.

Tip

• If an individual loses their job and medical coverage, it is best to take continuation coverage. This protects an individual from being denied coverage due to a pre-existing medical condition. Some states offer more protection above and beyond HIPAA.

Downside

• HIPAA does not require an employer to offer health insurance or guarantee what is covered in a group plan. In addition, it does not prevent an employer from imposing a reasonable waiting period before coverage can begin regardless of whether a person has a pre-existing condition.