When Is It Too Late To Get Health Insurance?


I hate having to be the one to give people bad news but in my line of work it is occasionally required.

Here is a phone call I recently received.

“I need medical care and I have no insurance. Can you help me?”

Unfortunately, there is nothing I can do for anyone after they are sick or injured.

If you elect not to pay premiums for health insurance while you are healthy, unless you are a child, there is no health insurance that is available to cover your medical bills, at this time.

Even with juveniles who were protected from pre-existing condition clauses by the PPACA, it can be pretty hard to get them insurance after they have been diagnosed with something.

The phenomenon of people not paying for health insurance until they need it has a specific name.  It is called, “Adverse Selection.”  Both extremes of  the political spectrum agree that the practice is unfare to both the insurance companies and everyone else that pays health insurance premiums while they are relatively healthy.

Guaranteed acceptance for adults does not occur until 2014.  Health insurance companies are still free to medically underwrite (investigate and approve based on health history) applications. 

No private health insurance company that I am aware of will approve an adult applicant for a medical condition that is not under control.

That does not mean that just because someone takes medication to control a physical problem, they cannot get health insurance.  There are a handful of conditions that are automatic declines but most cases with pre-existing conditions emphasize control.

For example, a person with a thyroid condition that has seen a doctor and is taking one prescription to control it will typically have fewer problems getting health insurance than a person who is ignoring their thyroid condition.

In many states a person is required to be accepted onto a group health insurance plan regardless of their health.  On the surface that sounds like a good idea but be aware of the fine print.

Most group policies have a “pre-existing” condition clause.  That means that unless there is a state mandate that supersedes it, insurance companies will not pay for any medical treatment for a condition where a reasonably prudent person would have sought medical treatment in the prior 2 years.

For example, a new hire would be added onto an existing group plan.  Here in Texas, if she or his spouse was currently pregnant and the plan offered maternity coverage the mother to be would have health insurance benefits from the first day.  If, however, he or she had cancer, they would not have medical benefits for 18 months unless they qualified to have the pre-existing condition clause waived under HIPAA.

(HIPAA is the law that allows people to change from one group health insurance plan to another without having to satisfy the conditions of the “pre-existing condition” clause. 

Essentially, the law says that if a person had a “credible” group health insurance plan and elected to change employers, the pre-existing condition clause would be waived and anything that was paid towards the deductible from the prior group plan would be credited to the new group plan.)

This does not mean that a person cannot get medical care if they have no insurance.  It just means that they need to pay the doctor and hospital directly and not rely on a 3rd party, like an insurance company, to pay their bills for them.

High Risk Pools

With the passing of the PPACA, there is government sponsored High Risk Pools that will insure people with pre-existing conditions.  Just be advised, there are some limitations on them.

The Federal High Risk Pool will cover the medical expenses of an individual but it requires a person to go a minimum of 6 months without health insurance before they may enroll in the program.

Some states, like Texas, decided that their state run high risk pool was already sufficient and they elected not to form a federal high risk pool.  Be advised, however, that while these plans will accept people with pre-existing conditions, they often have a pre-existing condition clause that will rule out paying for any medical care for a pre-existing condition unless you can meet the HIPAA standard of credible health insurance coverage before you enrolled.

Moral

The moral of the story is, “Don’t wait until you are sick to get health insurance.  If you want assistance paying your medical bills, get health insurance while you are in average health. “

I know that health insurance is expensive but it is relatively a minor expense compared to the potential medical bills that can occur from an accident or disease.

If you have no health insurance at all, I encourage you to shop around and get some.  You can shop and submit your application by clicking on one of the red boxes on your left for the health insurance company you prefer or visit our web site for plans in Texas, Indiana or Michigan.

If you cannot find a plan that you can afford, call our office at 832-767-8059 and maybe we can help you over the phone.

Please help me keep from having to break bad news.  If you have no health insurance at all, contact myself or your local health insurance agent and get something while you are healthy.

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