Can You Get Health Insurance If You Are Already Sick?

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Actor Ewan McGregor has faced space monsters in Star Wars, and heroin addiction in Trainspotting DIS. However, when it came to dealing with a tiny mole on his face, McGregor needed some real-life help, big time.


The Scottish star, whose newest film, Deception (NWS) opens April 25, revealed to a BBC reporter on April 22 that specialists had recently removed a malignant mole from underneath his right eye. He did not disclose when the surgery took place, and said the cancer was "not a big deal."


For an accomplished independent contractor, such as McGregor, that may be so. But if you do not have an employer to provide insurance, cancer, even after it is gone, may make it more difficult for the rest of your life to receive health insurance coverage. That is because cancer usually falls under the category of a preexisting condition, according to Tony Lehrman, CEO of the health insurance brokerage Lehrman Group, based in Tucson, Ariz. An individual who works alone and is seeking health insurance for only himself or herself will have a hard time getting insured for preexisting conditions, says Lehrman. “Insurance companies are not benevolent. Not one of them,” says Lehrman. "They err on the side of their stock brokers."


A health insurance company can define a preexisting condition however it pleases, which means it can be almost any ailment including diabetes, an STD, asthma, depression, anxiety or infertility treatments, he says. "Some companies, if you’re taking Prozac, they won’t cover [you]."


However, every state has different standards for how insurance companies must serve their citizens. Some states mandate that an insurance company must offer insurance to anyone who wishes to buy it, according to Lehrman, although they may charge extra for a person who has what the company deems a preexisting condition. Other states will ask someone who wants insurance to wait 90 days after a treatment or after surgery before the company will supply coverage. Still other states allow an insurance company to deny coverage to anyone, he explains.


According to the non-profit Kaiser Family Foundation, federal law mandates that companies with two to 50 employees must be issued health insurance no matter what, which is called a guaranteed issue. (Federal law does not mandate that individual employees are guaranteed issues.) Therefore, working for a company with a group health insurance plan is the best bet for someone with a preexisting condition, since that person may be denied if he or she sought health insurance on their own, Lehrman says.


Another way to get health insurance is for a person to be hired at a company with a group plan, quit their job, and then sign up for COBRA (Consolidated Omnibus Budget Reconciliation Act) health insurance, which will cover a former employee (or a retiree or a former employee’s spouse or dependent children) at a group-rate after his or her employment has ceased. An employee is eligible for COBRA as soon as the employee becomes eligible for their employer’s group health coverage, a date which varies by company. COBRA coverage typically lasts for 18 months but can extend up to 36 months depending on the circumstances.


When an employee is covered under an employer’s group health care plan, the employer usually pays for a percentage of the employee’s health care coverage, says Amy Turner, senior advisor with the Labor Department’s Employee Benefits Security Administration. Under COBRA, however, the former employee incurs the full cost himself or herself, plus an administration fee. The former employee cannot be charged more than 102% for the cost of coverage per federal law.



If you’ve recently become unemployed and you have a preexisting condition, COBRA is an important option, Turner says. According to the HIPAA (the Health Insurance Portability and Accountability Act) law, individual employees (as well as former employees getting their health care from COBRA) cannot be charged differently on a group health plan, whether or not they have preexisting conditions.


Turner suggests that those seeking advice on the legal logistics of health insurance matters should contact the Department of Labor’s benefit advisors at 1-866-444-3272.



While offering counsel on which health insurance to purchase, Lehrman says he’s told clients "nobody’s going to give you the policy" after learning of their medical background. "It literally breaks my heart," he says. "At least 30% of the people who call us looking for insurance, we can’t help. But, you have to look at it from the insurance company’s point of view: Why should they be forced to give [someone] a policy when they know it’s going to cost them a lot of money?"

 

If you found this information useful, check out these posts: Arnold Couldn't Protect His Medical Records, Can You?, The New Identity Theft: Invasion of the Body Snatchers, and TV Doc's Credentials Questioned.

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