Until this month, I was one of the 45.6 million Americans—that’s 15.9 percent—without health insurance. For those without an employer-based insurance plan, it can be difficult to get affordable (if any) coverage if you’ve had more serious health problems than a bruise.
When I left my job, I figured that as a young, healthy nonsmoker, it’d be easy to get affordable coverage. Then, I was denied. My crimes? Antidepressants (years prior) and fainting once when I had the flu. When I finally found a bare-bones plan that I could handle ($125 per month), the process left me soured. What about those who have serious health problems, or who can’t afford $125 a month? Why is it so hard to get insured in America?
Not Perfect? No Coverage
Whereas an employer with a group insurance plan can’t deny you coverage, companies selling individual insurance usually can, thanks to medical underwriting—which is basically medical background checks. It allows insurance companies to pick and choose who they cover, and at what price, based on perceived “risk,” which is code for cost. Medical underwriting is only illegal in New York, New Jersey, Maine, Massachusetts, and Vermont.
There’s a misconception that this only affects crack addicts and cancer patients, but that’s not the case. Routinely denied are those with asthma, allergies, diabetes, or migraines. You can be denied for things in your past, such as an abnormal pap smear, infertility treatments, or an MRI (even if it showed you were healthy). Coverage offered despite a “pre-existing condition” is often more expensive, and may actually exclude coverage for the condition in question.
Pay Up
Pre-existing condition or no, health insurance isn’t cheap. And since it’s tied to employment for most Americans, many are out of a job and out of insurance at the same time. Many unemployed people find it difficult to justify an added monthly expense—not to mention that $100 a month won’t even get you decent health coverage. Plans with low premiums generally have a high deductible and/or don’t include things like dental and maternity services. Sometimes, they don’t even include prescriptions. An HMO plan on par with the coverage at my old job was quoted at $600 a month. For those with chronic health problems, coverage for prescriptions and specialists can be vital. Deductibles have to be affordable, because you will likely have to pay them.
Carissa Bluestone, 30, a Seattle-based freelance editor and writer with Crohn’s Disease, was denied private health insurance in Washington State. Even though she was eligible for state-funded WSHIP, a plan with a $1,000 deductible would have cost her more than $300 per month. She waited for her upcoming wedding instead, and got covered under her husband’s insurance. But that didn’t include dental and she is now facing $5,000 in dental work, in addition to paying to have her wisdom teeth removed. “I’ll probably have to borrow money from my parents,” she says. “I’d really like to stop doing that since I’m thirty and, by most people’s standards, make a comfortable living.”
Covering Your Ass and Working the System
Know your state policies. Each state has its own set of complex rules about health insurance. Contact your state’s department of insurance.
Twenty-eight states have a high-risk pool that you can join if no private insurer will take you. You usually have to prove residency of at least six to twelve months, and it might not be cheap. As an example, a thirty-year-old Oregonian will pay $149 to $250 per month in premiums.
An excellent resource for state-specific information is Georgetown University’s Healthinsuranceinfo.net. Always double-check with your state’s insurance office to be sure.
Don’t say no to COBRA without a back-up plan. COBRA is a federal law that requires companies with twenty employees or more to offer you the same insurance you had at your job when you leave for any reason. The catch? You pay the entire premium—up to nine times what was extracted from your paycheck. In my case, that was about $400 per month.
