Past medical history and health insurance
February 26, 2013 3:33 PM   Subscribe

I'm in the United States and will be working for myself for the first time. This is exciting, but I have a pre-existing health condition, ADHD, and I take medication daily. Will this still be covered if I go on my own health plan or will this be out of pocket? I'm male, non-smoker, mid-20s with no other pre-existing conditions. The whole new health care initiative is confusing, I was under the impression that this sort of thing is now covered.
posted by anonymous to Health & Fitness (7 answers total) 1 user marked this as a favorite
It depends a LOT which state you're in -- can you have a mod add that information?
posted by KathrynT at 3:50 PM on February 26, 2013

Here's a timeline of what goes into effect when (created by the place I work for, but I didn't have anything to do with this bit).

Pre-existing conditions don't have to be covered until 2014, is the short of it.
posted by rtha at 3:54 PM on February 26, 2013 [2 favorites]

I pay for my own ADD doctor out of pocket as well as the meds.
posted by Ideefixe at 4:35 PM on February 26, 2013

Depending on what kind of work you do and where you're located, you may have the opportunity to buy into a "virtual group" rather than purchasing individual insurance. Some Chambers of Commerce offer access to group health insurance for small businesses and sole proprietorships who are Chamber members; many professional organizations also offer group insurance.
posted by Sidhedevil at 4:38 PM on February 26, 2013

The insurance side will vary, but my uninsured housemate gets her prescriptions at Costco for much lower than she would pay at any other pharmacy. She doesn't have a Costco membership; you can just go use their pharmacy. I don't know if this is true outside of Oregon, but it's worth investigating.
posted by linettasky at 7:55 PM on February 26, 2013

On the East Coast you could look into Freelancer's Union. Intended for self-employed freelancers, generally in the arts, but that may not be a requirement.
posted by citygirl at 7:56 AM on February 27, 2013

Take a careful look at the documentation for the health plan that you are considering. It is possible that the preexisting condition clause can be waived if you can prove that you have had insurance coverage for a previous specified time period - usually 18 months with no gap longer than 63 days, but it could vary.

If you've been on your parents' insurance or a previous employer's all this time and you are now getting your own, you can request a Certificate of Creditable Coverage from the old insurance which is the proof you would need.

There may also be a rule that you have to disclose your condition up front before they decide to cover you. Lots of people like to keep this kind of thing from the notice of their insurance company, and there are reasons for that, but it's also usually true that if you lie on the insurance application forms, you run the risk of them not covering ANYTHING once they find out, not just this condition.

Disclaimers: If you've had a gap of insurance, none of this applies and IANAnInsuranceExpert, so these statements are not any guarantee that it is all true - read the documentation.
posted by CathyG at 12:47 PM on February 27, 2013

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