Will I be able to go from medicare to private insurance?

February 26, 2009 10:48 AM

If I lose medicare, will I qualify for private insurance?

I am on medicare due to disability. I am now well enough to work, so i may be losing medicare. But due to my disability, I have a preexisting condition which exludes me from buying private coverage.

I live in california.

I understand that as long as I have continuous coverage, I can get insurance even if I have a pre-existing condition.

I have heard, however, that medicare does not qualify. Does medicare qualify? Will I be able to get insurance?

posted by TigerCrane to law & government (4 comments total)

Have you tried calling this number and asking? I have no first-hand experience with this, but it looks like they might be able to answer that kind of question.
posted by craichead at 11:00 AM on February 26

Without knowing your health history this is impossible to judge, but know that the issue is not quite as cut and dried as you make it out to be. Insurers will not necessarily automatically disqualify you from buying a policy if you have a pre-existing condition, though they certainly can. But if they do offer a policy, they'll usually pull one of two dodges to protect themselves:

1) They may impose a period (frequently six months or more) where they will not cover said conditions.

2) They'll charge you an outrageous premium.

Sometimes they'll even do both. But health benefits procured through an employer (good luck there, by the way) generally don't exclude people as a result of the contractual relationship with the employer.

Suggestion: see if you qualify for Medicaid, which is targeted at the poor, unlike Medicare, which is targeted at the elderly and disabled with less consideration of their financial status.
posted by valkyryn at 11:40 AM on February 26

I could be wrong, but I think that the OP is assuming that he or she will get insurance coverage through his or her job. They're not allowed to deny you coverage because of a pre-existing condition. They are, however, allowed to exempt that particular condition from coverage for a period, unless you've had continuous coverage. The question is whether Medicare counts as continuous coverage. It's a fairly technical question. I think you need to find an expert.

If you do need to get individual insurance while you look for a job, look into the state high risk pool. It's likely to be very expensive, but it might be better than nothing.
posted by craichead at 11:59 AM on February 26

Generally, you shouldn't automatically lose Medicare just because you're now working, if your disability level hasn't changed. There's a bit of an overview about the rules regarding working disabled people and Medicare here. I'm guessing that if you've gone through the entire process to qualify for Medicare, you probably already know that, I just wanted to make sure that you're not assuming you'll lose benefits when that might not be the case.

If you are facing losing Medicare, you should look into the California Working Disabled program--it's a program that the state has set up for people in your situation, who are disabled but able to work. There's limits on how much income you can make, and if you qualify you'll be expected to pay some sort of premium, but I can almost guarantee that it will be vastly cheaper than anything you'd get in the private market. Plus, the benefit package is based on Medi-Cal, which will cover many, many more things than even really good private or employer insurance would.

If you don't qualify for the California Working Disabled program, it looks like your Medicare coverage would count as continuous coverage for HIPAA purposes, as long as you had it at least 18 months and a break in coverage of no more than 63 days before getting private insurance. Starting on page 36 of this guide, you can get some information about buying private insurance in California when you're disabled. If you're HIPAA-eligible, that means that insurance companies who sell individual insurance policies have to offer you at least two policies, and can't impose a pre-existing condition rider on those. However, it's not guaranteed to be cheap (it only has to be less expensive than the "average premium" for people in the state's high risk pool), nor is it guaranteed to cover everything you want or need covered--in California, HIPAA plans have to be the two most popular individual products the insurer sells, not the most comprehensive. In other words: search around, and read benefits summaries carefully.

If you're being offered insurance through your job, you're in much better shape; they can't take your disability into consideration when deciding whether you're offered the plan, how much you need to pay, and what your plan covers--it's got to be the same for all similarly-situation employees (for example, all full-time employees have to be treated the same). Your Medicare coverage should qualify as continuous coverage in terms of pre-existing conditions, as long as you're able to actually enroll in the plan within 63 days. (Note that some companies don't let anyone sign up for insurance until after they've been an employee for a certain length of time--watch out for this, because it could affect your HIPAA rights.) It's probably still worth looking into the California Working Disabled program, though, because depending on how much money you make you may find you'll get better coverage through the state for cheaper than with an employer plan.

You could also look into the state high risk pool if you can't find decent individual coverage. More info on how to qualify for that, as well as the monthly premiums you'd be looking at, here.

The people at Disability Rights Advocates might be a really good resource for you if you have questions or want to find a helpline or other resources to walk you through the process. Good luck, and congrats on getting a job, especially in this economy!
posted by iminurmefi at 12:13 PM on February 26 [1 favorite]