Currently, 38 states plus the District of Columbia have laws that allow health insurance underwriters to automatically decline applicants with chronic pre-existing medical conditions. These conditions include cancer, heart disease, kidney dialysis and severe mental disorders like major depression or schizophrenia.
Starting in 2014, health care reform will compel insurers to accept all applicants for any individual or group health benefit plan.
In the meantime, 13 states have laws that oblige insurance companies to provide at least some form of guaranteed health coverage. This privilege applies to all Americans including those with potentially fatal pre-existing conditions in their medical histories.
States that Guarantee Issue All Medical Insurance Policies
Five states require health insurers to sell their full portfolio of medical insurance policies to individuals regardless of chronic pre-existing conditions. These are:
- Maine
- Massachusetts
- New Jersey
- New York
- Vermont.
To do business in New York state, insurance providers must guarantee that all individual market plans are sold to all applicants.
Other states appear to be somewhat less forgiving on applicants with pre-existing conditions. That finding is based on the Kaiser Family Foundation’s comparison available on StateHealthFacts.org.
In Washington state, health insurers have to guarantee issue all products only for applicants who achieve a minimum score on a health status questionnaire or screening.
Other States that Guarantee Issue Medical Insurance
The seven states below mandate that insurers sell at least some form of medical insurance coverage. Often, that coverage has benefit restrictions or is priced to account for anticipated higher claims. The states are:
- Idaho
- Michigan
- Ohio
- Oregon
- Rhode Island
- Utah
- West Virginia.
If you’re refused individual health insurance in Idaho for health reasons, that insurer must offer you the option to buy a High Risk Reinsurance Pool (HRP) plan. Those plans have limits on pre-existing condition exclusion periods that can be imposed.
Michigan residents with a pre-existing condition can buy individual health insurance from a Health Maintenance Organization (HMO) during an annual 30-day enrollment period. State law also dictates that Blue Cross Blue Shield of Michigan sell individual health insurance to any resident.
Ohio also prescribes certain times of year when you cannot be turned down because of your health status, age, or any other factor including a pre-existing condition that might predict your use of medical services.
In Oregon, it is illegal for an insurer to impose a pre-existing condition exclusion period because of your genetic information. Genetic information includes the results of a genetic test and your family’s medical history.
To be eligible for a guaranteed-issue medical insurance policy, Rhode Island residents with a pre-existing condition must have 12 months of creditable coverage with no gap. If so, health insurers must offer a choice of at least two policies with benefits similar to medical coverage sold to everyone else.
If the Utah Comprehensive Insurance Pool (HIPUtah) refuses to cover you, private insurers are legally required to offer you a basic health insurance plan.
HMOs in West Virginia sometimes run an annual enrollment period during which you can buy medical coverage even if you have a severe pre-existing condition. If not, health insurance may be available from the AccessWV high-risk pool.
Tips for Qualifying for Medical Insurance with a Pre-Existing Condition
If you do find health insurance coverage, you should continue following your doctor’s advice to treat your pre-existing condition. Health insurance underwriters look favorably on any positive steps you take to improve your health and deal with existing medical problems.
You can also possibly qualify for lower medical coverage rates by becoming a non-smoker and sensibly losing weight.
An improved diet, regular exercise and an ongoing commitment to treating your pre-existing condition add up to a small price when you want to qualify for hard-to-find medical insurance.
Sources: This article presents independent calculations and insights based on source data from StateHealthFacts.org and Health Insurance Consumer Guides for the Fifty States.
Daniel Workman - A senior business and finance writer who also does French translations, notably international trade and insurance materials.
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