Health Insurance

coverage for medically uninsurable individuals
Health insurance Health coverage for medically uninsurable coverage for medically uninsurable individuals
Health insurance
Health coverage for medically uninsurable
coverage for medically uninsurable individuals

Health insurance



Health Insurance Issues: Coverage for Medically Uninsurable Individuals

It may not seem fair, but there is a group of people who are considered to be "medically uninsurable" by health insurance providers. This means that they are likely to have excessively high medical expenses in the future due to pre-existing conditions like cancer and diabetes. Even pregnancy is sometimes included in this health insurance category. A pre-existing condition usually means that you have a health issue that began before you sought health insurance coverage. It's estimated that about 2.5 million Americans fall into this category. Even seasonal allergies and prescription drugs (if you use them for a long period) can cause you to be termed as medically uninsurable by insurance providers if these conditions are documented in your medical records.

Although many people are uncomfortable with government involvement in private health insurance issues, in some cases this involvement is almost a necessity. Those 2.5 million people are in greater need of health insurance coverage than many others, yet most private insurance companies decline to cover them. To address the problem, more than 30 states have established HIPs (high-risk insurance plans) that are chartered, non-profit entities. HIPs have the positive effect of serving high-risk patients in a segregated environment that doesn't drive up the cost of health insurance for others. This article discusses some of the available health insurance options for those who are considered medically uninsurable by private carriers.

In some cases, states can require private insurers to offer coverage to anyone, regardless of their health status. These plans are called guaranteed issue policies and they are designed to serve 3 basic classes of people: those who have pre-existing medical conditions, those who want coverage for a future pregnancy and those who do not qualify for traditional health insurance for medical reasons.

Another way to obtain health insurance for people with high-risk conditions is via health insurance pools. These are private insurance plans that are self-funded. Their sole purpose is to provide health insurance to persons who could not obtain coverage elsewhere. In some states, these pools are independent entities. In other states, they are arms of the state's department of insurance. Consumers buy their coverage directly from the pool.

Related high-risk pools are high-risk reinsurance pools. In these pools, people purchase health insurance from individual insurance companies or carriers rather than from a pool. Once purchased, the carriers spread the risk by placing these policies into a pool. Some states do not use insurance pools. Instead, they designate a "carrier of last resort" that must issue insurance to high-risk individuals.

To qualify for health insurance from a risk pool, a person must be a resident of the state that is providing the coverage. In addition, the person must provide proof that either health insurance or payment for a pre-existing condition has been denied by a carrier. In some cases, coverage may be summarily denied if a person has a certain disease or condition or is a prison inmate. It can also happen that a pool's member capacity is reached and no new members are accepted until a place opens up.

The plans offered by insurance pools fall into 3 basic types: limited benefit, mini-medical and major medical. Limited benefit coverage has fixed benefit levels for common medical services like doctor visits, surgery, hospital care and more. Mini-medical plans have copays for doctor visits, medical tests, prescription drugs and more. Major medical features multi-million dollar coverage for practically any medical treatment or disease you can imagine. Major medical is becoming rare and difficult to obtain. Each of these plans has its own set of good and bad features. Be sure to thoroughly investigate all options before choosing a plan offered by a risk pool. It's especially important to know whether the plan has a waiting period before coverage kicks in for pre-existing conditions. This can happen if there's been a lapse or gap in your coverage, meaning that there's been a period (however short) during which you have not been continuously covered by a medical insurance plan. In some cases, the waiting period can be up to 18 months.

Even if you're in the medically uninsurable category, it is possible to obtain quality health insurance coverage from a variety of providers, both public and private. Although such coverage is likely to be more expensive for this class of policyholders, it may be possible to keep costs down via government subsidies.




Health coverage for medically uninsurable
coverage for medically uninsurable individuals Health insurance Health coverage for medically uninsurable
coverage for medically uninsurable individuals