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Finding Health Insurance if You Have a Pre-existing Condition

By Meredith Ledford on November 25th, 2009
Health Insurance

The Elusive Task: Finding Health Insurance Coverage With a Pre-existing Condition

Finding affordable health insurance is hard enough if you're healthy. It's even harder if you are unhealthy, or have what is known as a pre-existing medical condition. Simply put, a pre-existing medical condition is a health condition you have before the beginning of your first day of coverage through a new health insurance policy. Oftentimes, these conditions can make health insurance unobtainable in the individual health insurance market, regardless of your age, gender, or ability to pay.

Get Health Insurance Quotes with Rules in Mind

However, knowing the rules of the individual health insurance market can help you in your search for affordable health coverage. Here are three concepts you should keep in mind during your search.

1. Individual health insurance regulations vary by state. It can be argued that there is no such thing as an American health insurance system, that the individual health care system in the country is actually comprised of 50 different insurance systems, each operating under its own rules, laws, and regulations. For this reason, the comprehensiveness of coverage an insurance company offers--and the premiums it charges--vary by state.

Before beginning your search for a health insurance carrier and policy, be sure to visit your state insurance department's Web site for information regarding the health insurance regulations in effect in your state. Additionally, state laws differ regarding what is known as the "look-back period" and "pre-existing condition exclusions"--two concepts that we'll turn to next.

2. Underwriters of health insurance can review your medical history. In the individual health insurance market, there is the concept known as a "look-back period." These periods are set amounts of time that underwriters of health insurance policies can look into your medical history to decide if the policy should cover a medical condition you currently have. For example, if you were treated for hypertension in the past 6 months, depending on the state, this information may or may not be available for review by the underwriters of your insurance policy in determining your insurance coverage and rates.

According to a recent white paper by the Robert Wood Johnson Foundation, look-back periods in states "range from 6 months or less in 15 states to unlimited look-back periods in 13 states." Be sure to know the look-back period in your state before beginning your search, or you may be looking for an ever-elusive health insurance policy.

3. If you find coverage, it may include a "pre-existing condition exclusion." This concept means exactly what it says: a health insurance company may grant you affordable health coverage but may exclude coverage of your pre-existing condition. Working with the example above, a health insurance company may determine that you are eligible for coverage but could decide not to cover any services related to to your hypertension.

According to the Robert Wood Johnson Foundation report, 38 states allow health insurance providers to exclude a condition permanently. However, if the health insurance provider chooses to limit coverage for a defined period of time, most states limit exclusion periods to 12 or 24 months. Such an exclusion could prevent you from obtaining coverage associated with the condition that may have precipitated your search for health insurance in the first place.

Health Reform and Your Pre-existing Condition

While searching for an affordable health policy that will cover services for a pre-existing condition is daunting, there is good news. Current health reform efforts include consumer protections that would prohibit health insurance providers from discriminating against you if you have pre-existing condition. In the meantime, understanding these concepts and the rules of the game in your state will help you in your search for that elusive policy: coverage with a pre-existing condition.

Once you've done some research about the regulations governing your state's insurance market, submit a request for a free online quote from multiple insurance agents.

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