If your health insurance is, or was until recently, provided by an employer or union, you should read up on your legal protections. Key among your rights to continued coverage are two separate but coordinating federal laws known as COBRA and HIPAA, and they are particularly important for anyone with a pre-existing health condition. Understanding both your rights and responsibilities under these laws can help you and/or your dependents maintain eligibility for group coverage. Note that the federal COBRA law applies to employer group plans with more than 20 employees only, but your state department of insurance can tell you about your state’s ”mini-COBRA” law for those in plans with fewer than 20 employees.
Individuals not eligible for group coverage can try to purchase health insurance on their own, for themselves and/or their family members. But it is important to have realistic expectations about the individual insurance market. Knowing something about eligibility rules can spare you the time and frustration of applying for coverage only to be turned down without explanation. For example, only a handful of states currently guarantee health coverage for individuals regardless of health status: Maine, Massachusetts, New Jersey, New York and Vermont. As of today, children under the age of 18 with pre-existing conditions can no longer be denied access to individual plans. Adults living everywhere else are likely to be denied if they apply for it on their own and have a pre-existing condition. This will change in 2014 when the Affordable Care Act prohibits individual plans from excluding people with pre-existing conditions. Applicants with even minor conditions such as allergies can be denied, or at best approved for very limited or expensive policies. You also should be aware that individual health insurance may be even more expensive than group or COBRA coverage.
As a result of the Affordable Care Act, new Pre-Existing Condition Insurance Plans (PCIPs) have been implemented in all 50 states and are available for purchase to individuals who meet the following eligibility criteria: you must be a US citizen, have been uninsured for at least 6 months, and have a problem getting insurance due to a pre-existing condition. The PCIPs were created as temporary health coverage until additional reforms kick-in in 2014 and other options are available.
Other possibilities may exist depending on where you live, your age, disability status or other factors. Fortunately, several online resources now exist that make researching your options easier. To learn more about the programs and protections in your state, check one or more of the following insurance tools:
- US Department of Human Services-Healthcare.gov-Find Insurance Options-This site will provide a personalized insurance report dependent upon your current insurance situation. (Also in Spanish)
- The National Council of State Legislatures - State Health Programs to Cover the Uninsured - This site features state health programs and examples of health reform measures in many states to expand coverage to the uninsured.
- Georgetown University Health Policy Institute - Consumer Guides to Getting and Keeping Health Insurance - Offers information for each state, as well as guidance on managing medical debt and more.
It may take some time for you to determine your best course of action, and you should feel free to ask an MS Navigator™ for help at 1-800- 344-4867. And bear in mind that going without health coverage for more than 63 days will result in the loss of some legal protections, which is why we urge everyone to stay insured if at all possible.
- Medicaid and other public health insurance options
- Prescription drug help
- Finding low or no-cost care
- Managing your personal finances, with or without health insurance
Last edited November 2010.