Individuals who have spent most or all of their lives on group insurance are often surprised when they have to go through underwriting (the process of reviewing one’s medical records) as part of the individual health insurance application process. After reviewing an applicant’s medical history, an insurance company can issue a policy at the preferred rate with no restrictions, at a higher rate due to the applicant’s pre-existing conditions or issue one which excludes the applicant’s pre-existing conditions. They can also decline applicants due to their medical conditions. If you or a family member has a medical condition that makes buying health insurance a challenge, these tips will help you navigate the most recent choices.
1. Before you apply for health insurance contact a health insurance broker (an agent who represents multiple companies). They often have underwriting guides for the companies they represent and can help you determine which company would be most likely to provide you coverage or the lowest premium. Since health insurance companies have different models for evaluating risks, you might be declined by one company and accepted by another at their “preferred rate”. Since you will pay the same premium for a policy whether or not you use a broker, it is wise to take advantage of their expertise. This is especially true with the recent consumer friendly changes to health insurance.
2. If you have recently lost your job and have a pre-existing condition (or a dependent with one) that makes it difficult to find health insurance, do not throw away your COBRA letter. This might be your best option for health insurance. COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) gives workers the right to purchase group health insurance for 18 months. Since you have 60 days from the time you receive your COBRA letter to decide if it is your most affordable option, this is the time period to do your shopping. Your COBRA offer can be compared with the offers from the companies your health insurance broker recommends. COBRA can be accepted for a dependent even if you do not accept it for yourself.
3. Since COBRA is temporary and there is the possibility that you may not find a job with group health insurance during the 18 months, do everything possible to improve your health. Losing weight and quitting smoking are two lifestyle changes that can lower your rates or decrease your chances of a decline. To be considered a non-smoker you must not use tobacco for 12 months.
4. Once you have exhausted your COBRA you may be eligible for the Inclusive Health-State Option. This is a government sponsored health insurance with premiums based on your age, sex, whether or not you smoke and which of their four plans you choose. Inclusive Health will not decline applicants due to their medical conditions. Applicants can be turned down if they have a spouse who is eligible for group health insurance. Inclusive Health’s web site is www.inclusivehealth.org and their toll-free number is 1-866-665-2117. In addition to having customer service agents to assist you, they also have a list of agents by county that can meet with you in person or provide you more personal attention over the phone. If you have not had a gap of more than 63 days in your health insurance coverage all your pre-existing conditions are covered by their policies. Pre-existing conditions are not covered for 1 year for policy holders who have gone longer than 63 days without health coverage. Applicants must mail their application no later than the 15th of the month to begin coverage by the 1st of the following month.
5. Inclusive Health offers a subsidy to members with a low income. To obtain this discount you can complete the IH Assist application at the time you apply. This discount is based on household size and income. A copy of the applicant’s 2009 tax return is required to verify household size and income.
6. A child 18 or younger who is healthy or has pre-existing medical conditions may qualify for reduced or free government sponsored health insurance if his parents have a low income. For additional information contact the NC Division of Medical Assistance at 800-367-2229 or www.nchealthystart.org.
7. If you have been six months or longer without coverage and have been declined for health insurance, you may qualify for Inclusive Health- Federal Option. These plans are based on your age, whether or not you smoke and which of their four plans you choose. The Federal Option has lower premiums than the State Option and is funded by a temporary Federal High Risk Pool, which resulted from the Patient Protection and Affordable Care Act.
8. Since I have had several clients declined due to incorrect information on their medical records, I often advise my declined customers to order 5 years of their medical records from their primary care physician. If they discover incorrect information they can ask their doctor to correct the mistake and appeal the insurance company’s decision.
As an agent who is trained to assist Inclusive Health applicants and frequently helps individuals who have pre-existing conditions or have been declined by health insurance companies, I will be glad to help anyone who has questions. You can call my office at 919-845-6001, or click here to contact me via email/form.
