Medical Insurance With Pre-existing Conditions

The issue of pre-existing medical conditions is a contentious one in the health care industry. The problem occurs when individuals with a medical condition have a gap in receiving health insurance. In some cases, when they seek new coverage they are deemed ineligible because of the pre-existing condition. It's a situation in which business and health care models can clash, leaving patients in the lurch. For most people, there are alternatives to explore when a pre-existing condition is preventing them from getting health care.

Identification

• A pre-existing condition is a medical issue which was present prior to applying for a health insurance policy. This issue can result in higher insurance premiums or even a denial of the application for insurance.

Types

• The types of pre-existing medical conditions that can result in denial of coverage vary with insurance carriers. Common pre-existing conditions include arthritis, diabetes and fibromyalgia. Even conditions such as depression, pregnancy or obesity may result in denial of coverage.

Considerations

• The problem of pre-existing conditions generally comes up when people change insurance policies, such as when they are between jobs. If you are in this situation, it is important to keep documentation that you had a previous insurance policy. Though it varies by state, there is generally a time frame in which you can change policies and not be subject to a pre-existing condition clause.

HIPAA

• The Health Insurance Portability and Accountability Act (HIPAA) is an important federal law that deals with preexisting conditions. This law protects people as they change group health insurance plans and requires that some type of insurance plan be made available for those with pre-existing conditions. In general, this law covers people who are moving from one group health insurance plan to another, and eligibility can be affected by how long it's been since you were last insured.

Options

• Having a pre-existing condition usually won't totally exclude someone from getting health insurance. Unfortunately, the main option is usually a policy with very high premiums or placement into a high-risk insurance pool. The high-risk pool is a state-supported insurance plan designed for individuals with pre-existing conditions, who cannot otherwise be insured. It is an expensive option, but it does provide health insurance for those with potentially costly medical issues.