Health Insurance for Pre-Existing Heart Conditions

Heart disease is a pre-existing, chronic medical condition affecting millions of Americans, and it can be difficult for people with this disease to find health care coverage. If you have heart disease, it's critical that you avoid breaks in health insurance coverage that could trigger a pre-existing condition exclusion.

Extent of problem

• Millions of people in the U.S. are unable to find health coverage

  About 6.5 million people with heart disease, high blood pressure or stroke are uninsured, and most report difficulty in obtaining health insurance or changing jobs to guarantee coverage, according to the American Heart Association.

  People who lack health insurance experience up to a 56 percent higher risk of death from stroke than those who are insured, according to the American Heart Association. They are also more likely not to take necessary medications and avoid timely medical care.

Individual health plans

• As of 2014, health insurers in the group and individual markets can no longer deny someone coverage based on health status including preexisting conditions. Until then, though, there are a few options available for health coverage.

COBRA benefits

• The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law that gives people the right to temporarily continue with the group insurance plan of an employer even after you leave a job--voluntarily or involuntarily--or when you reduce your hours, such as from full-time to part-time.

  The coverage generally is for 18 months, longer under certain specific circumstances. The downside is the coverage is often unaffordable, as the person must cover 100 percent of the premium and a 2 percent administration fee.

High Risk Pools

• People with heart disease can seek coverage in high risk insurance pools

  People with heart disease who are considered "medically uninsurable" and have been uninsured for at least six months will be eligible for new state-run temporary high risk pools, scheduled to open in late June. The pools will operate until 2014, when the new insurance exchanges, in which companies will compete for insurance business, are scheduled to be up and operating.

Public insurance options

• If a person is unable to work due to heart disease, they may qualify for Medicare coverage if they have received Social Security Disability for two years or Medicaid coverage for people with disabilities.

  If a person is retired military or a dependent of a military member, they can qualify for coverage through VA benefits or TRICARE, the managed health care system for active members of the U.S. military and their dependents.

Children

• Pre-existing conditions can apply at birth. Newborns born with heart problems have been denied health insurance coverage on the basis of pre-existing conditions

  Children with congenital heart defects who can't get health insurance coverage can no longer be denied insurance based on pre-existing health conditions starting in 2010.

Federal protections

• Under federal HIPAA law, people with pre-existing medical conditions cannot be denied group health coverage through an employer. If the plan generally provides coverage, but denies benefits because a person had a condition before your coverage began, the federal law applies.

  A group plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. A pre-existing condition exclusion period can be imposed for no more than 18 months or less time (or none) if the person shows they had prior health coverage.