ASK KIM


When You Can't Get Health Insurance

Kimberly Lankford

You might be able to get coverage through your state's high-risk pool if insurers are turning you down because of your medical conditions.



My father-in-law is a self-employed plumber in Billings, Mont. He's in his mid-fifties and had a severe coronary-artery blockage that caused heart-attack symptoms. In 2005, he had a stent put in to open the blockage. He has sought a high-deductible health-insurance policy for years but has been turned down repeatedly. What options does he have?

The availability of health insurance for people with medical conditions varies by state, so your father-in-law should consult with an insurance agent familiar with his local market (find an agent through the National Association of Health Underwriters).

Tom Tattory, an agent in Missoula, Mont., told us the three carriers in his area have become very strict about heart conditions, especially ones that result in blockages and stents. "It's generally a flat-out denial," says Tattory.

But your father-in-law still could get coverage. In cases like his, Tattory refers people to the Montana Comprehensive Health Association, the state's high-risk health-insurance pool, which must accept people who have certain illnesses or have been turned down by private insurers. Montana's pool offers three plans, with "comprehensive coverage you'd typically find in other insurance plans," says Tattory.

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For instance, the policies have deductibles of $1,000, $2,500 or $5,000; they pick up 80% of eligible medical bills; and they have generous prescription-drug coverage. A 55-year-old would pay $472 per month for a plan with a $5,000 deductible and an annual cap of $7,500 on out-of-pocket costs.

High-risk pools are a good solution for people with medical conditions, but only 33 states have open pools. Some states charge higher premiums than Montana does, offer less coverage or have long waiting lists.

To find out about options in other states, contact the state insurance department (see our insurance page for links). The Georgetown Health Policy Institute also offers state-specific guides for getting and keeping health insurance at Healthinsuranceinfo.net.

For more strategies for finding health insurance on your own, see You Can Get Health Coverage.

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




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