Getting Affordable California Insurance with a Pre-Existing Condition?
June 13, 2006 8:47 AM   Subscribe

Getting Affordable California Insurance with a Pre-Existing Condition?

I am a 21 year old female dancer living in New York with pretty good insurance that is New York only...I am moving to Los Angeles in a week and was going to switch to Tonik Health (a CA health insurance for healthy young people) but since I didn't know when it would kick in, I decided to go get a physical, blood tests, etc. before I left.

Well, great. My blood tests came back and showed a very VERY minor condition that will just require me to go to the doctors once a month for six months for a blood test to check the mineral levels. It's like a non-problem, they just found I had a gene for something that COULD cause problems when I'm 60, and as long as I stop drinking I'll be OK, which is fine by me.

Now, I don't qualify for Tonik and the other places I call say that my rates are going to be ridiculous. I am SO bummed 'cause if I had just waited and found out in LA, this wouldn't be a problem, and I've NEVER EVER been sick before or used ANY of my insurance, but now I am not going to be able to afford insurance (unless you fab mefites can help!!

Help! Thanks in Advance!
posted by citystalk to Health & Fitness (11 answers total) 2 users marked this as a favorite
I am not a medical professional or a lawyer, but I believe that they are allowed to base life insurance on your medical profile, but not medical insurance. Also, if you have insurance now, it should mitigate many items under HIPAA legislation.
posted by slavlin at 9:55 AM on June 13, 2006

As long as you get health insurance in your new location soon, i.e., without a significant gap in coverage of more than 60 days, then your pre-existing coondition will be covered--as long as it is covered under the new plan's benefits.
posted by deadfather at 10:04 AM on June 13, 2006

Except that your question was about affordability ... sorry. Individual health insurance rates are indeed often based on your medical history. Hopefully someone else can give local advice.
posted by deadfather at 10:05 AM on June 13, 2006

Have you spoken with a California-based insurance agent? Such a person might be able to help locate a plan that would meet your needs.

I suspect that the agent would probably offer you a plan that excludes coverage for your "very minor condition" and other conditions that might develop related to it. And, on the affordability issue, you would probably need to accept a plan with a quite high deductible in order to lower your premium. An agent can help you locate one or more options.

Since you are young and healthy, you might be o.k. with the exclusion for your "non-problem". You'd have to pay the cost of those doctor visits and lab tests yourself, instead of having them covered by your insurance. The trade-off would be getting lower rates. In any case, even if you didn't have the exclusion, the doctor visits would probably be applied to your deductible.

Data point: I am self-employed, I was turned down for coverage in TX for a pre-existing condition, and I now have a plan that costs ~$350/month with a $2500 deductible. I am switching to a $5000 deductible plan later this year.
posted by Robert Angelo at 10:41 AM on June 13, 2006

You probably want an insurance BROKER. If I remember right, an agent is tied to one company.
posted by small_ruminant at 10:50 AM on June 13, 2006

As far as I know (IANAIA), California has very favorable legislation that makes it difficult for an insurer to deny you coverage on the basis of pre-existing conditions.

Specifically, take a look at this site ( I believe the section that applies to your case would be "Special Standards for Individual Health Plans".

You should contact an expert. Did I mention that you should contact an expert? You should contact an expert. You absolutely do not want to attempt to navigate the health insurance system without an advisor who thoroughly understands it.
posted by scrump at 11:12 AM on June 13, 2006

The state of California has a report card for insurers in the state. I went to the Blue Cross website and went halfway through the quoting process for an individual plan, and it seemed relatively inexpensive for a person your age. They had what looked like a relatively good tool for helping you to determine the right plan for your needs.

Most of the other companies (Kaiser Permanente, Blue Shield, etc.) should have similar options for getting an individual quote.

I'm not familiar with the state laws of California, but it appears California insurers are allowed to deny you coverage/increase your rate/exclude coverage based on a pre-existing condition. If you think it's a non-issue, that may not be a big deal, but if you're expecting the insurer to pay for the blood test/doctor visit, it may or may not work out. Good luck!

You probably want an insurance BROKER. If I remember right, an agent is tied to one company.

Speaking as an insurance broker, I can tell you that you're going to have a hard time getting an agent or a broker to help you as no commissions get paid on individual plans.
posted by MarkAnd at 11:13 AM on June 13, 2006

1) Look into one of the high deductible plans. They may be more likely to insure you with one of those. You'll pretty much be paying out-of-pocket for most of your care but since you're young you probably won't need it too much.

2) You're probably already working your ass off as a dancer, but you may want to consider getting a part-time job that offers benefits. At some point after your benefits kick in, you can quit and pay for COBRA coverage for 18 months. Of course, you'll have to do the same thing all over after the 18 months are up, but at least it'll get you through for a while without breaking the bank.
posted by stefanie at 11:52 AM on June 13, 2006

i love you all. just knowing that people have a few answers (and great ideas) makes me feel less concerned...i've just been thrown for a loop! i was randomly diagnosed (so random, just a regular PCP who randomly had tons of experience with this ridiculously rare condition, so decided to order the DNA test "just in case") with a gene for a condition that isn't usually found in people until they're like 60! i don't even have the problem, just a huge likelyhood to have it if i drink and don't take care of myself (which really i don't mind doing). hence, the blood draws to see what happens when i stop drinking cold turkey (as opposed to the normal girls night out three days a week, lol). i'm thrilled to have caught it before the gene did cause something but have my insurance kicked up for the next 40 years for something that really is a non-issue suks.

i will be back after i've read through everything! i've been a lurker FOREVER and have never posted anything but have LOVED this site since I found about about it!

ps - note to everyone, if you ever think you might have a condition, or if your doctor suggests testing, do NOT go through your insurance and instead do private blood testing! that way, you're only out $200 bucks if you don't have it and if you do you have time to get your insurance straight. xoxo
posted by citystalk at 12:06 PM on June 13, 2006

citystalk, I am too dorky to know how to post hyperlinks, but here are some URLs for Cal insurance information.

If these aren't helpful, perhaps they can lead you to the right info. I can't get insurance in California, but I'm not young and healthy like you! Once you get it, never let it go. Good luck with the move, and best wishes.
posted by shifafa at 8:42 PM on June 13, 2006

Actually, if you withhold information when applying for insurance that is required or requested on the application, then you are guilty of insurance fraud.
posted by slavlin at 7:13 AM on June 16, 2006

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