Health Insurance for People Who Have Pre-existing Conditions

Obtaining health insurance when you have pre-existing conditions is possible even if you are unable to obtain coverage through your employer. The Affordable Care Act, passed in March 2010, isn't scheduled to go into effect for many provisions until 2014. Until then, states offer coverage through high-risk pools or through interim plans established through the Department of Health and Human Services. You may also live in a state that offers guaranteed issue policies regardless of health risk.

Group Insurance

• By law, group insurance policies are required to accept all people applying for coverage within a group. The most common type of group insurance coverage is through employers. For many people with pre-existing conditions, obtaining insurance through an employer's group policy is usually the easiest route.

Guaranteed Issue States

• Five states--Maine, Massachusetts, New Jersey, New York and Vermont--require all insurance carriers to offer coverage to individuals applying for insurance regardless of health status, age or risk. The state of Washington has a similar program, but the applicant must meet a minimum score on a state mandated health status questionnaire. If you don't meet the minimum score, you are referred to Washington's high-risk pool.

High-Risk Insurance Pools

• If you have a pre-existing condition that prevents you from acquiring an individual insurance policy in a state that does not mandate guaranteed issue, the state may offer a high-risk insurance pool. Because high-risk pools are designed for people with health issues, the premiums will be fairly high. The pool may offer limited benefits, such as not including prescription coverage, but this varies from state to state.

Insurance through the Department of Health and Human Services

• Effective July 1, 2010, the Department of Health and Human Services is offering guaranteed-issue health insurance for people with pre-existing conditions. The plans are a part of a program that will fill the gap until 2014, when insurance companies will have to offer insurance to individuals regardless of health risk as mandated in the Affordable Care Act signed into law in March 2010. Twenty-nine states will administer their own programs under this offering, while the Department of Health and Human Services will oversee the remaining 21 state plans. The department has a website that will help you figure out your insurance options (see Resources).

Elimination Periods and Exclusions

• If you have been uninsured for a period of time (61 days or more in most states), your insurance policy may contain an elimination period for pre-existing conditions. This means that the insurance policy will cover treatment for illnesses not related to the pre-existing condition. For example, if you are a diabetic, during the elimination period the insurance company will not pay for treatment related to your diabetes but will provide coverage if you fall and break your leg. Once you keep the policy through the elimination period, the policy will also cover diabetic treatment. Elimination periods vary by state but are usually around 12 months. If a condition is excluded from coverage, an insurance company will not cover any treatment related to that condition.