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Lupus and Health Insurance

Posted Jul 27 2009 12:00am
I had an email last week asking me abut Lupus and insurance coverage (this person was considering leaving his/her job for a new one). As for me I do not have health insurance. I am self employed and to get insurance for myself can be quite costly, more than any doctors visit I might need (and there are prescribtion coverage plans you can get without the health insurance cost).

So it took me a few days to research this and I must tell you it was more than I wanted to know. For me, I have no other conditions (besides CD) and do not take any prescription drugs. And since Homeopaths and Naturopaths are not covered by insurance it doesn't affect me as much as someone who goes to an MD. And there was a time tha I did go to an MD and it did cost me, but once I said I had no insurance and would have to pay cash I recieved a slightly discounted price than the insurance carrier might be paying.

Anyway here is what I came up with, I hope it helps someone
As we all know Lupus would be considered a "pre-existing condition", however more like diabetes than pregnancy or chemotherapy. Because Lupus is a chronic condition (i.e. never goes away...or so they thing) and is not considered a "costly" disease like AIDS and Cancer and the drugs for lupus are meant to "maintain" the body, most insurance carriers will cover you but you must be up front immediately with them. Tell them your condition (I'm in remission or in a flare and these are the drugs I take). In some situations the company may charge you a higher rate than your fellow coworkers (or a higher rate where as you will have to pay the difference between it and what your new employer already pays for you).

If you have lost your job and are on Cobra you are covered so long as you get coverage within sixty days through your previous employer's health insurance company (as well as some other companies, but the easist is through the one you have already dealt with).

If niether of these situations apply to you and your are looking for Open Enrollment health coverage, contact your state insurance department. Links to the state insurance departments are posted at . Since many of these plans are administered by the local Blue Cross associations , it makes sense to also call them directly. A listing of high risk health plans is posted at .

Individuals in Arizona, Delaware, Florida, Missouri, Ohio, Tennessee, Virginia and West Virginia who meet the federal eligibility requirements can apply for coverage with Golden Rule Insurance without being required to meet eligibility requirements. The issued policy will cover the pre-existing medical conditions. However, it will save time if you tell the enrollment adviser that this is a HIPAA application rather than a regular medically underwritten policy.

If you are unable to find an open enrollment health insurance plan through your own search, OnlineAdviser offers free assistance finding this type of health insurance although we are not able to provide enrollment support for these plans. See for details.

“Web surfing” is not a good way to find an individual health plan that covers pre-existing medical conditions. Commercial health insurance plans found on the Internet do not offer this type of coverage provision, yet some people are lured into enrolling for plans that seem to offer this coverage.

Some open enrollment health insurance policies require a “Certificate of Creditable Coverage” in order to access immediate coverage for pre-existing medical conditions. If you have a “Certificate of Creditable Coverage” and live in AZ, CA, DE, DC, FL, MO, NC, TN, VA, WV there are more health plans choices available that provide takeover benefits. In the worst case, the applicant must wait 6 to 18 months under the new coverage pay for the cost of treating pre-existing medical conditions.

Unfortunately, the laws that assure that we have access to health insurance do not regulate the price of this insurance to make sure that it is affordable. The range of premiums for the open enrolment high risk health insurance coverage goes from about $200 per month for single coverage in parts of the Midwest to more than $1200 per month for the better plans on either coast. Family coverage is 2.5 to 3 times the price of single coverage. Some states limit the price of coverage for high risk applicants at 200% of the price charged for healthy applicants.

The less expensive insurance but limited benefit coverage by Basic Health Insurance , Core Health Insurance , " Value Health " and " Value Med " may be necessary when other types of insurance is either unaffordable or unavailable. These plans provide far less coverage but offer a premium price that most people can afford. Some insurance coverage is better than no coverage at all. The cost of these typically range from about $50 to about $400 per month.

When health care expenses are not covered by insurance it makes sense to bypass insurance altogether and use a Preferred Provider Organization (PPO) discount health savings plans instead to cover the cost of pre-existing conditions. Plans like Ehealthdiscountplan can be effective because they cover all pre-existing medical conditions. This is not insurance, but sometimes it is better to pay cash for smaller expenses, especially if the bills are discounted under a PPO agreement. Both doctors and patients prefer this cash pay-as-you-go method because there is no risk of dependency on insurance approval. The combined cost of the cheaper health insurance plus the out-of-pocket cost of pre-existing coverage not covered by insurance is often less that the cost of an open enrollment plan that offers takeover coverage.

PPO discount health plans are very liberal, available to almost everyone, cover a wide range of expenses, include pre-existing medical conditions, and cost little compared to the savings achieved. As a result, these plans tend to be favored by those who use them. See the article " Comparing Health Discount Plans " for more information.

Discount health plans should not be confused with health insurance policies but unfortunately some unscrupulous marketers intentionally blur the line between the two types by offering discount plans in combination with limited benefit insurance. Be sure to understand the distinction between the two types of benefits.

Individuals seeking insurance to cover pre-existing medical conditions are frequently the victims of scams or unethical marketing programs. Many consumers under pressure to get medical treatment do not realize the limitations of insurance and enroll in a health plan that they believe will pay more in medical expense benefits than the cost of the premium. Obviously that would not be a sound insurance program. It seems that as soon as one of these health insurance scams is shut down by authorities, another surfaces to take its place. Insurance regulators in all 50 states and the District of Columbia have warned consumers to avoid unregulated health insurance plans. The best approach is to realize that a health plan that seems to good to be true probably is exactly that.

Availability and price of coverage varies significantly from location to location. It might be wise to consider the availability and price of this coverage in states other than your own. Consider, for example, a case where a family would face tens of thousands of dollars in medical insurance and out-of-pocket costs in their own state but could manage fairly well under the rules of another state. Uprooting a household to move to another state for medical treatment might sound extreme, but there are plenty of real-life cases where this made the difference in keeping a family together for the long term (just giving you something think about!).

Not elligable for regular commercial health care due to pre-existing medical conditions? Then you may be eligible for any of the following five categories of limited benefit health insurance plans and takeover the costs of pre-existing medical conditions. While these provide less protection than regular major medical insurance, they are less expensive, have more liberal medical eligibility requirements and provide more liberal coverage of pre-existing medical conditions. At least one of those five types of coverage is available on a guaranteed issue basis to almost all U.S. residents.

1) Core Health Insurance - a limited benefit insurance available to U.S. residents (citizenship not required) in most states that accepts all applicants under age 65 regardless of medical history and pays for pre-existing medical conditions with the following limitations: a) a waiting period of the first 30 days following new policy issue applies for doctor's office sickness benefits, b) a 12 month waiting period applies for hospital and surgical benefits for pre-existing medical conditions. Other coverage for pre-existing conditions begin immediately in the same manner as any other covered expense. Amounts of coverage amounts vary depending on the coverage options and premium amount selected, so it is possible to adjust the insurance benefits to fit a specific budget. Maximum lifetime benefit from this policy is $1 million. Unlike most limited benefit insurance plans, doctors and hospitals may bill this health plan directly and take direct assignment of claims payments. See the "Plan Details" section online for a full description of coverage. Coverage is issued online and can be in force on the next business day following application. For all of the reasons summarized here, Core Health Insurance is often the best choice for a person with significant pre-existing medical conditions when other medical insurance is unavailable or unaffordable. The waiting period of 30 days/12 months for the substantial coverage of pre-existing medical conditions is the most generous currently available in commercial health insurance market. For this reason, we believe that Core Health Insurance should be the first consideration of those who cannot enroll (either due to eligibility or cost) in major medical insurance.

2) Basic Health Insurance - a limited coverage plan is available in most states that admits all applicants under age 70 regardless of medical history and pays for pre-existing medical conditions after being enrolled for 6 months. As the name implies, this insurance covers limited items and not all medical costs. See for information about availability, rates and enrollment.

3) The five Value Benefit plans including - " Value Health USA ", " Value 24 Hour Accident ", " Value 24 Hour Accident Coverage ", " Value Emergency Room Insurance " and " Value Med " insurance can be used in combination or separately where available. Unfortunately, some of these are not available to those with the most severe and chronic medical conditions like AIDS, cancer, insulin dependent diabetes, and cardio-vascular disease. Value Health is a hospitalization and surgical cost policy and Value Med is an outpatient policy that helps pay for doctor visits, lab tests, emergency room and ambulance costs. Value Med recently added optional coverage for expanded hospitalization benefits making this the most well-rounded plan available to date). Both are limited benefit policies that are not designed to cover the full amount of larger medical bills. See the description of coverage for the specific coverage limits. These policies are available in most states to individuals. Pre-existing medical conditions are covered under both Value Health and Value Med plans after the policy has been in force for 12 months (the waiting period is 6 months in ID and NV). Both of these can be used in combination with Basic Health Insurance and Core Health Insurance above to increase overall coverage.

4) Public assistance plans - When disposable income and assets available are less than the cost of health insurance, each state has one or more programs that provide free or reduced cost health insurance. These welfare policies pay for the cost of pre-existing medical conditions after the coverage has been in force for the prescribed length of time, usually six to eighteen months, depending on the state and the program. These plans vary from community to community and change frequently. The easiest way to find the welfare health insurance plans available in your area is to look in the blue pages of your local telephone book under the term welfare office and ask the staff there. Many uninsured children of middle income Americans are eligible for coverage under a program called "Insure Kids Now". See the article titled "Trends in Children's Health Insurance" at for more information.

5) High risk health insurance pools - If no other option is available, each state has at least one open enrollment high risk health insurance plan that will accept all individuals not eligible for coverage under any other health plan. Coverage for pre-existing medical conditions is not immediate unless the applicant has maintained coverage under a group insurance or short term medical insurance for the previous with not more than a 2 months gap in coverage. If a gap in coverage of more than 2 months, then a waiting person of 6 to 18 months before the pre-existing condition coverage becomes effective. There is no requirement that the waiting period be satisfied on the any health insurance plan, so many people use an inexpensive short term health insurance to satisfy the waiting period an then switch to the assigned risk plan. Finding and enrolling in these plans is covered in the next section.

See a state by state listing of product availability for all health insurance products. This chart is designed to help make the lower cost option visible "at a glance" on a state e state basis.

OK, that's it....I'm done....and now you know why I don't have insurance!
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