Insurance for pre-existing conditions

August 27, 2007 11:32 AM

I'm young and currently healthy, but I've had a lot of health problems in the last year. When I quit my job at the end of the year, will I be able to get insurance?

I mean a lot- I've had physical therapy, an ER trip, lots of diagnostic imaging and bloodwork, and probably a few dozen doctor visits. It's all things that aren't currently a problem, but could potentially recur, including ovarian cysts (not PCOS) and an RSI.

I have to quit my job at the end of the year, to go back to school part-time. It's not negotiable, and I can't transition to part-time at my job. I'll most likely be temping to pay the bills. I've checked out the excellent suggestions on MeFi for individual insurance, but I'm afraid that I'll be denied because of my recent history.

Am I completely screwed? Should I expect total denial, or just high premiums and a high deductible? Is it even worth applying?

posted by anonymous to Health & Fitness (16 answers total)

Assuming you're in the U.S. (or you wouldn't be worrying about whether you can get insurance), do you qualify for COBRA coverage through your soon-to-be-former employer, and can you afford it? That would give you 18 months more coverage from your current plan.
posted by magicbus at 11:39 AM on August 27, 2007

Get COBRA and DO NOT LET IT LAPSE. Once your COBRA has lapsed, insurance companies can and will attach riders to your future policies, allowing them not to pay for things that happened to you before you got insurance through them.
Can you get insurance through your school? Call up your school benefits office and ask them immediately, if not sooner.
posted by Sara Anne at 11:43 AM on August 27, 2007

Yes, COBRA is your best (though likely the priciest) immediate option. Take COBRA (no matter how much it costs -- seriously, borrow the cash from your parents if you have to; do everything you can to avoid putting it on a credit card, though) don't let it lapse (not even for a month), and use the 18 months you'll have to find another plan (whether a group plan or higher-risk individual plan) that won't screw you on the pre-existing conditions. The process will probably be fairly maddening, but it can be done -- I've done it myself (and I had cancer as a pre-existing condition to deal with). Good luck.
posted by scody at 12:10 PM on August 27, 2007

Have you looked into getting insurance through your school, or even through your temp agency? I'm not sure if part-time status excludes these options, but I figured it was worth mentioning.
posted by amtho at 12:23 PM on August 27, 2007

What state do you live in? Some states (e.g. MA) do not allow insurers to reject people because of preexisting conditions. If you let your insurance laps there may be a waiting period, but they will have to insure you.
posted by alms at 12:30 PM on August 27, 2007

Get COBRA and DO NOT LET IT LAPSE
Make this your mantra. Can't emphasize this enough. If you can't get COBRA or get insurance through your school, look into short-term insurance - the underwriting isn't so strict. But that will only last for 6-12 months, and after that you'll need to get into a group health plan. Never, ever, let there be a gap in your insurance because, most likely, you won't be able to get individual insurance due to the pre-existing conditions. It's an unfair fact of life.
posted by la petite marie at 12:44 PM on August 27, 2007

More specifically, you cannot let your insurance lap for more than 62 days. I don't know why that's the arbitrary number, but it is.

Better not to let it lapse at all.
posted by xmutex at 12:51 PM on August 27, 2007

As everyone has said, do not let your COBRA eligibility lapse.
However, COBRA isn't forever. Coverage, generally, ends after 18 months. If you do not have group insurance lined-up by that time, you will have to find private insurance. Welcome to hell.

If you have to go the private policy route, all of your pre-existing conditions will be considered during underwriting, probably resulting in riders for those conditions.

Definitely look into insurance possibilities through the school or any other potential group plan before you go down the private policy route.
posted by Thorzdad at 1:34 PM on August 27, 2007

62 days=the longest possible period that two months could be. Basically, they wanted to make the law say "two months," but they wanted to make sure that you wouldn't get screwed if your two month period happened to fall during February or April or something, so they specified 62 days.
posted by Amy Phillips at 2:06 PM on August 27, 2007

You might not even have the ability to elect COBRA continuation coverage. Small employers are exempt, although your state may have enacted COBRA-like legislation for continuation coverage for employers with 2-19 employees.

This is one of those situations in which there are no good options. You are likely to discover that COBRA premiums (or individual insurance premiums) are so expensive that you can't afford to pay them. Good luck.
posted by MarkAnd at 2:14 PM on August 27, 2007

I've had a hell of a time getting individual health insurance. All medical conditions I've had were either years in the past or otherwise cured, and both Blue Cross Blue Shield and Humana have hit me with "we do not cover people who have had those conditions." (For Individual only, of course. Because I've been covered by both companies under group plans.) And I mean, day to day, I'm wicked healthy. I only go to the doctor periodically because they tell me to.

I've had more success going through my university's alumni association. They seem to be telling to me that I can get coverage through them, but the app process is not yet complete.

I do recommend COBRA, as I think they'll take you, but for me that was a premium situation where there was no way I could afford it for more than a few months. While you're on it you can explore other options.
posted by iguanapolitico at 2:28 PM on August 27, 2007

Does your school offer student health insurance? If your parents have a group plan, are you young enough to be covered on it?

Your current group health plan may offer a conversion option. This would allow you to get individual coverage without underwriting (i.e., without looking at pre-existing conditions). Your benefits would different (worse), as would your premiums (higher).

Also many states have a high-risk pool. You have to have run out of options (COBRA ineligible or run out; denied for individual coverage), and the premiums are quite high.
posted by expialidocious at 5:24 PM on August 27, 2007

Lock down your COBRA coverage and the money to pay for it. Then immediately get to work interviewing insurance brokers. A good one knows the idiosyncracies of each plan, and can guide you toward those least likely to turn down someone with your particular medical history. (Though note that whatever you disclose to the broker, they're obligated to disclose to the insurer. So you may want to discuss hypotheticals or general disease types rather than get overly specific about your personal history.)

A good broker also helps you to avoid applications traps. e.g. Mine recommended only doing paper apps, never electronic, because you can attach as much explanation/clarification as necessary to make your point that IT'S REALLY NOT A PROBLEM.

That strategy of where to apply and how much detail to share with the insurer, is critical, even if you're less than thrilled with a particular plan. Because the first question on an individual policy's app is usually "Have you been turned down by another carrier?" Once you have to start answering yes to that one, getting an application approved becomes so much harder. Remember applying to college? Always have a Safety School Insurance Policy. Then if you do have to be turned down by your top choice, you've still got a backup plan ready to go.

Also, if you get turned down by any carrier, have the broker guide you through the appeal process. Use your appeals! I got turned down for ridiculously minor pre-existing, fully resolved, conditions. Won the appeal, though. Whew. If they turn down your first appeal, ask where you can appeal that one too. There may be an authority higher than the company, such as a state consumer rights panel.

Temp agencies love to tout their group health insurance option but few temps can meet the eligibility requirements. If you can manage it, apply instead for a job with one of the companies that extend their group plan coverage to part-timers. Being on a group plan gives you so many more rights and security than individual. Individual should be your last resort.

Finally, be clear on exactly what question is being asked on an app. Don't assume that just because you've used a bunch of medical services lately that you meet the underwriter's
(and state regulator's) definition of pre-existing condtion. Usually the questions are not "have you had a bunch of lab tests lately". It's more like "has a doctor told you that you have, or might have, or need to be treated for, condition blah blah". If you had a bunch of lab tests etc that didn't lead to a diagnosis or treatment plan, you may have less trouble than you're anticipating.
posted by nakedcodemonkey at 5:44 PM on August 27, 2007

Unless you have a friend who happens to be an insurance broker, going to an insurance broker is likely not going to get you anywhere. Individual medical policies don't pay commissions and they're confusing and annoying and a lot of work and are the product most likely to create a lawsuit and a claim against your errors and omissions insurance. Maybe if you buy a ton of individual life at the same time, but probably not even then...
posted by MarkAnd at 5:58 AM on August 30, 2007

Unless you have a friend who happens to be an insurance broker, going to an insurance broker is likely not going to get you anywhere.

I disagree -- after my COBRA ran out and before I got group coverage through my current employer, an insurance broker (who was not a friend, though she was recommended by a friend of a friend) was exactly how I finally found interim individual coverage that accepted me despite my history of cancer. She didn't try to sell me any other products, either.
posted by scody at 9:57 AM on August 30, 2007

MarkAnd, do you have a cite for that? Maybe it's something in your state. The (California) broker I worked with collected a commission, as do other brokers. It's built right into the premiums of all individual policies. eHealthInsurance.com makes a mint off commissions paid for the individual policies it helps sell.
posted by nakedcodemonkey at 10:37 PM on September 2, 2007