Ask Kim


Getting Health Insurance on Your Own

Kimberly Lankford

You have some special options if your COBRA coverage is ending and you have preexisting conditions that make it difficult for you to get health insurance.



Since I lost my job nearly 18 months ago, my health insurance has been covered through the COBRA program. Now my COBRA eligibility is about to end, and I still don’t have a job with benefits. I have some health problems, so I don’t think I can qualify for a policy on my own. Is there any chance that Congress will extend COBRA eligibility beyond 18 months? Or should I wait for the new high-risk pools to open?

Even though thousands of people are nearing the end of their COBRA coverage , Congress is unlikely to extend eligibility beyond 18 months for people who lose their job. But you do have several alternatives. Despite your health problems, you may qualify for an individual policy if your condition is well managed. To get price quotes from several insurers in your area, contact eHealthInsurance.com (call 800-977-8860 to discuss your health situation rather than requesting an online quote), or find a health-insurance agent in your area at www.nahu.org. An agent can help you gather letters from your doctors and other key records that could strengthen your case and help you qualify for coverage.

If you have major health problems, however, you might be rejected for coverage. But because you’re coming off COBRA, you have access to some special health-insurance options. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows people who exhaust their COBRA eligibility to buy certain policies regardless of their health condition as long as they don’t have a gap in coverage longer than 63 days.

HIPAA coverage, which varies from state to state, doesn’t come cheap. Some states limit HIPAA policies to 145% of the cost of a standard health-insurance policy, but others permit insurers to charge up to 300% of the standard cost. In some states, all insurers must offer a HIPAA plan to eligible applicants regardless of preexisting conditions; in other states, one insurer provides all HIPAA coverage. And some states provide coverage by letting HIPAA-eligible people into their high-risk pool without a waiting period. For details about your state’s rules, go to www.coverageforall.org, or contact your state insurance department (you can find links to the state departments at www.naic.org).

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Don’t wait for the new high-risk pools. The health-care-reform law specifies that you must be uninsured for six months to qualify for one. If you have a health condition, it could be dangerous to go that long without health insurance. Instead, start the HIPAA application process at least a month before your COBRA eligibility expires so that you don’t end up with a gap in coverage.

And whether you have a HIPAA policy or you qualify for an individual plan, you may be eligible for some assistance in paying health-insurance premiums. Twenty states have Health Insurance Premium Payment (HIPP) programs, which help low-income people with medical conditions pay private health-insurance premiums. Go to www.coverageforall.org for more information about your state’s rules.

Got a question? Ask Kim at askkim@kiplinger.com.



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