Insurance For High-risk Buyers

By Author: Marcus Stalder
Total Articles: 491
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Finding adequate health coverage in case you have a serious health condition can be not quite as easy as with healthier customers. But it's still possible, only that people with health conditions usually pay higher fees and have to wait longer for their insurance plan to kick in.

When it comes to defining which conditions are considered serious and which are not, every company has its own definitions for them. But in most cases insurance companies agree the following to be of a high risk:

- cancers of most types
- heart diseases
- nervous system issues
- AIDS and other serious diseases

Group coverage

Prior to the 1996 adoption of the Health Insurance Portability and Accountability Act (HIPAA), workers looking for group coverage from their employers were often rejected or had their serious conditions excluded from coverage altogether. After the HIPAA has taken force it guaranteed that all workers who are eligible for group coverage can get one regardless of any pre-existing conditions. The document imposed certain requirements over insurance providers, such as:

- waiting period ...
... not exceeding one year
- no waiting period if your diagnosis or treatment were made more than six months ago

In most states these regulations are even more generous towards those looking for group health insurance with pre-existing conditions.

Individual coverage

HIPAA also assures that buyers with pre-existing conditions can obtain individual health coverage by using two sources:

- high-risk pools (specialized in providing coverage to people with pre-existing conditions)
- private insurance providers (who can't refuse you with coverage if you are eligible)

Health insurance coverage can be quite expensive

Getting insurance from high-risk pools can be quite costly as the rates can be twice the amount you will be charged by an ordinary insurance company. Still, the majority of high-risk pools have 25-50% higher rates than the standard ones. But it's the price you have to pay in order to get individual coverage if you are considered a high risk by typical providers.

To learn whether high-risk pools are available in your state you can contact your state insurance department or the National Association of State Comprehensive Health Insurance Plans.

In case there are no high-risk pools in your state you should seek health insurance plans from a private insurance company. In that case, if you have a pre-existing condition the company has no right to keep you waiting before you can get your coverage. On the other hand, private insurance companies can charge you whatever amount they may find suitable.

You have to understand that insurance companies are assuming high risk when insuring a person with a serious pre-existing condition. That's because such persons tend to require more care and call for medical services more often than persons with no pre-existing conditions, pushing up the costs of coverage above average. Don't get offended by such trends, it's just the way things are.

And don't forget that the rule of comparison shopping also applies. No one is forcing you to get the first plan you get a quote for. Try getting as much quotes from different companies in your state as you can and compare them. Sometimes you may find a provider who will charge you the same rate as a person with no serious health concerns. Also keep in mind that your condition could be considered as a high risk in one company and could be within the norm in another one.