Can I get affordable insurance with a pre-existing condition after living abroad?

June 14, 2010 12:37 PM

Should I keep my US-based health insurance while I am working abroad for a year in Japan? I have a pre-existing condition.

I am going to work in Japan for 6 months to a year. I will have health insurance through the Japanese government while I am there. I am currently in the USA and I am insured through an individual plan because I did not like the terms of my employer's insurance. I have received treatment for depression in the past and my insurance has paid for part of that treatment. I would like to cancel my insurance policy while I am in Japan to save money. However, I am concerned that it will be very expensive or difficult for me to get another individual insurance policy when I come back to the USA in 2011. I am currently paying around $120 per month. I know that the reforms involving pre-existing conditions and insurance companies will not go into effect until 2014.
So, if you have experience with living abroad and being insured, what would you advise me to do? And MeFites with pre-existing conditions similar to mine, how hard has it been for you to get a new policy?

(This is only anonymous because I feel like it might be too much personal information to attach to my account)

posted by anonymous to Health & Fitness (10 answers total)

I don't think anyone has any idea what the health insurance market is going to look like at the end of 2011. Some private carriers have already exited the market rather than deal with the regulatory uncertainty introduced by the 2010 legislation.

Regardless, I think what you really want to do here is see how alien* health insurance will interface with US health insurance. People really don't understand how pre-existing condition exclusions work, assuming that if they have a pre-existing condition it's almost impossible to get coverage or switch carriers.

In reality, all you need to do is produce what's called a "certificate of credible coverage," a document from a health insurance carrier saying that you had coverage in place up until the time you applied for new health coverage. This demonstrates that you aren't trying to freeload, i.e. wait until you get sick to pay insurance. As long as you have coverage from someone, and can prove it, carriers don't have to worry about this moral hazard, as the constant turnover of insureds from carrier to carrier makes that all come out in the wash.

The question then becomes how this works when we're talking about alien and US carriers, not just foreign and domestic carriers. What you're going to want to do is get in touch with your current health broker to discuss how you can get evidence of your coverage in Japan in a way that will satisfy US health carriers that you've been responsible. This is going to take some doing, as it isn't a question they're going to get every day. Don't accept "I don't know" or "No" for answers until you're convinced that someone at the carrier with the appropriate level of knowledge and authority has dealt with the issue.

This actually sounds like an interesting little project, and I think it'd be worth posting what you find.

*The insurance industry recognizes three types of insurance: domestic insurance is written by carriers that are domiciled in your state; foreign insurance is written by carriers domiciled in another state, and alien insurance is written by carriers domiciled in a foreign country.
posted by valkyryn at 12:45 PM on June 14, 2010

I have a friend who just moved to Paris for a year. He was required to get French health insurance to secure his year-long tourist visa, however after doing the same sort of thought process you are, he has opted to keep his US medical insurance plan (COBRA, paying considerably more than you are). He also has pre-existing conditions, and wasn't willing to roll the dice with regards to being able to get coverage when he returns to the US.
posted by kimdog at 1:22 PM on June 14, 2010 [1 favorite]

I have had to cancel an individual policy because it wouldn't cover me out of the U.S. for more than 90 days, leaving me with a gap in coverage that is not ideal for someone left to the individual market. If you plan to keep your insurance make sure it isn't voided if you're out of the country for a long time.

If your Japanese insurance will give you a certificate of credible coverage and US insurance companies will honor it then you should be okay. Getting straight answers on both (hopefully in writing) might take some effort.
posted by Bunglegirl at 1:37 PM on June 14, 2010 [1 favorite]

I wish you weren't anonymous because I would like to know more about what you find out. I couldn't get any straight answers from the internet, and hadn't got around to asking here. If you feel comfortable with sharing what you learn, please (m)email me. (I live in another one of the socialist countries, France.)
posted by whatzit at 1:42 PM on June 14, 2010

anonymous sez:
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I definitely plan to post a follow-up through one of the moderators when I figure this out. In the meantime, keep the comments coming! I am finding them very helpful.
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posted by whatzit at 2:00 PM on June 14, 2010

i don't have a preexisting condition but when i moved to japan to work for the japanese government i found the health insurance plan they gave me was very nice, and i didn't opt to cobra before i left the US. are you totally set on getting a similar individual policy when you get back? why not just aggressively pursue a job with a really great health plan when you return to the US?
posted by raw sugar at 2:04 PM on June 14, 2010

I went to grad school, where I was covered for my depression treatment. When I graduated, I had COBRA. Then COBRA ran out, so I went to insurance companies to see about an individual policy.

The average monthly premium was going to be $1000.00. That's JUST THE PREMIUM. Not the copay, not the yearly cap or whatever. THAT'S FUCKING INSANE. I'd get better treatment if I went off my meds and allowed myself to become unable to work. Hang on to that sweet, sweet $120/month plan for as long as you possibly can.

Also make sure to be aware of the laws in your state concerning pre-existing conditions and insurance. valkyryn's comment sums up the issues there quite well.

Sorry for the rant. Hopefully it illustrates how difficult it can be to afford private insurance with even a treatable, no-surgery-required illness like depression.
posted by Fui Non Sum at 3:57 PM on June 14, 2010

Expect to pay much more in premiums when you get back if you drop it.

I haven't been without insurance. When I had to change plans, because I was no longer covered under my mom's insurance, it was absolute hell finding a company that offered an affordable premium. Even "affordable" is way too much--I can only "afford" it because my parents, who are very well-off, continue to pay. My pre-existing condition is not covered. I fear that my chronic headaches and vertigo are symptoms of some problem that's going to make itself known later, or even that I'll come down with something for which headaches and vertigo are plausible symptoms, and treating it will wreck my family's finances.

This may change with the new legislation. Predictions seem to vary a lot. But if I was in your shoes I wouldn't drop the insurance, no. (Unless it was a foregone conclusion, like your new insurance making it invalid. I've never worked overseas so I don't know.) $120 a month is sweet, and I'd be happy to throw $1,440 towards keeping a plan like that. I'd save that much back in less than a year.

Then again, you don't mention your gender, anon, so it may be that you're a man and your new premiums would be significantly less than mine.
posted by Kutsuwamushi at 1:24 AM on June 15, 2010

Mod note: From the OP:

Bad news. I spoke to my health insurance company and they said that they would not be able to accept a certificate of credible coverage from the Japanese government and that they would not be able to cover me outside of my current state. So, I am canceling my policy. I don't know what to expect in terms of a premium when I return to the USA, but I do know that I will have to get through a 365 day waiting period when I sign up for a new policy.

posted by jessamyn (staff) at 9:41 PM on July 21, 2010

Good thing you checked. I suggest still trying to get the certificate when you're done in Japan — maybe another insurer will accept it?
posted by Bunglegirl at 3:41 PM on July 22, 2010