Private Health Insurance & Pre-Existing Conditions

Expect a denial of coverage or high premiums when searching for private health insurance if you have a health condition or disease. Some health insurance companies may offer you insurance but choose to exclude coverage for your condition. When you cannot obtain private health insurance due to a pre-existing condition, the federal Affordable Care Act of 2010 provides measures to guarantee coverage.

Private Health Insurance

• Anyone can apply for individual health insurance. If you are self-employed, unemployed or do not have adequate insurance through an employer, you might want to consider an individual policy. These policies can extend to you and your dependents. You must complete a formal application through the health insurance company or an insurance agent. The insurer will ask about your current health and if you have existing health conditions. If you answer yes, the insurer may deny you coverage, require that you purchase a supplemental rider to cover that condition or charge you a very high premium.

Pre-Existing Condition Insurance Plan (PCIP)

• As a provision of the Affordable Care Act, the Pre-Existing Condition Insurance Plan provides health insurance to those who meet eligibility requirements. These include three criteria: legal U.S. citizen, uninsured for over six months, and unable to obtain private health insurance due to a pre-existing condition. Some states currently administer this plan and the federal government administers it in the states that do not. The Affordable Care Act continues to evolve. By 2014, insurers cannot deny coverage to individuals due to pre-existing conditions.

Finding Coverage

• To find individual private health insurance, visit the websites of the insurers to apply and get information about plan options. Upon submission and review of your application, the insurer will notify you with a quote if approved, or a denial of coverage. If you meet the eligibility requirements for the PCIP, you can find information on the federal government's website, Healthcare.gov. You can link directly from this site to your state's plan or to the site to apply for the federal plan.

Bottom Line

• If you have pre-existing health conditions and cannot obtain affordable private health insurance, you can obtain government-sponsored health insurance if you meet certain eligibility requirements. As of 2011, the PCIP offers three plan options with premiums between $320 and $570. These options and premiums vary for state's that administer their own pre-existing health plans. For more information, you can call the U.S. Department of Health and Human Services at 866-717-5826.