Ask Kim
Getting Health Insurance on Your Own
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.
By Kimberly Lankford, Contributing Editor, Kiplinger's Personal Finance
June 1, 2010
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).
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.
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Reader Comments (6)
Posted by: gary altstadt at 06/02/2010 09:39:54 AM
Every time I read an article about "If you have to get insurance on your own?', the writer always mentions "If you have serious health problems, you may not be able to get insurance.". NOBODY ever mentions the specifics of how insurers underwrite you. ANY pre-existing condition you have is not covered. I had back surgery a few years back. No insurer will cover that. My wife occasionally has pain in her hand from arthritis. If she gets arthritis anywhere in her body, it is not covered. My son has allergies. The insurer covers NOTHING having to do with respiratory issues like the flu, bronchitis, etc. That's the biggest problem with not getting group coverage.
Posted by: Craig at 06/03/2010 08:22:20 AM
I haven't been insured for more than six months because of my heart condition -- no one will insure me. I lost my group coverage and they didn't offer COBRA. How do I apply for coverage with the new Federal High Risk Pool? I'm in Georgia. Thanks for any help!
Posted by: elie DELOUYA at 06/04/2010 09:57:30 AM
why is difficcult to adopt the French system they gave us the statue of liberty so let adopt there Health benefit program
Posted by: Jessica at 06/11/2010 09:53:07 PM
Craig, I had the same thing happen. I was able to get health insurance through a state-sponsored program. I had to prove I was kicked off COBRA and turned down by insurance company. The coverage is not too expensive, less per month than my COBRA benefits, but there is an annual $2500 limit on prescriptions and I have to pay large percentage of procedure cost. I just save all the receipts and tax deduct it. And keep looking for a job with benefits that won't kill me in it's own ways... Every article I have read about this lists eHealthinsurance, which I found to be useless. I think it is illegal for them not to offer COBRA benefits. You should do a search for Georgia state health insurance. Gary: Amen. Insurance is such a big business scam. Then even if you have insurance, they still have to bicker and quibble about the meds, which they still try to find a way to not pay for. The amount of money they spend doing research to kick people off of the insurance for failing to report teenage acne 40 years ago so they don't have to treat breast cancer has got to be about the same as if they just covered people in the first place. The gov plan scares me too: they are making it sound so great, not thinking about the families like you that are in loopholes: you have insurance, so you get to be counted by a politician as a success story, but what if one of the original things comes up (God forbid), like your wife needs a knee replacement b/c the arthritis progresses? That makes no sense that they won't pay for bronchitis treatment for your son; bronchitis is a separate and distinct illness caused by a bacteria not by allergies, although having allergies could in theory increase the likelihood that you get bronchitis. They really twist everything around. So by letting the insurance co's have these loopholes, people can still go bankrupt trying to treat their health issues which is kind of a stupid idea and does not really solve the problem, which is people going untreated and going bankrupt paying medical bills.
Posted by: Ralph at 06/17/2010 10:24:59 AM
I have to echo what others have said...insurance companies want to take zero risk. Since my COBRA is running out this month, we have been applying for individual coverage. My wife and I have been rejected for "pre-existing conditions". We have taken care of the issues and currently take no medications and are not under a doctor's care for those problems. Still, insurance companies quickly and adamently say no to covering us. Irony of the situation is that the only reason we found out about those problems and received aggresive treatment was that we had good insurance. Doctors were more than happy to take care of any issue as long as they could come up with a diagnosis that would get them paid. Now, this is our "health record" which seemingly will stand in our way of affordable coverage for at least another 3+ years.
Posted by: Lisa at 07/30/2010 01:20:52 PM
Every time I read an article like this and the comments below it, all I can do is think (in horror) that this is life in the United States...so very sad.