A: The federal Health Insurance Portability and Accountability Act (HIPAA), passed in 1996, helps people buy and keep health insurance, even when they have serious health conditions. HIPAA limits the ability of plans to refuse to pay for treatment of pre-existing medical conditions. HIPAA eligibility ends when you enroll in an individual policy, because the last day of your continuous health coverage must have been in a group plan.
HIPAA protects people transitioning:
To be HIPAA eligible you must:
Note: If you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.
A: "Creditable Coverage" refers to the number of days that a person has coverage without a break in which they are uninsured for 63 days or more. This credit for previous coverage under another group or individual plan reduces the amount of time that a new insurer can exclude coverage of a pre-existing condition. Under federal statute, this protection applies to people who are "HIPAA-eligible". The most recent insurer has the responsibility for providing proof of this coverage, called a "Certificate of creditable Coverage."
A: High-risk pools provide coverage for people who can afford insurance premiums, but cannot find insurers willing to sell them policies because of their current health conditions. High-Risk Insurance Pools were first established in 1976 in Minnesota, and now operate in 33 states. Many pools now serve as the "fallback" option under the guaranteed portability requirement of the federal HIPAA legislation for those individuals moving from qualified group coverage to individual coverage.
Most high-risk pools operate at a loss due to the expenses generated by the population covered. Pools are subsidized through service charges on hospitals, fees on insurers, and state or federal revenues. By law, premiums are capped in order to maintain affordability. To be eligible for federal grants, state insurance pools must set premium caps no greater than 200 percent of average premium costs. Most states cap their premiums at no more than 150 percent of average premiums. Differences in premiums charged among various states reflect both disparities in benefit levels among high-risk pools and variations in overall insurance costs.
A: A 2006 study illustrates what premiums would be for a 50 year old woman purchasing a $500 deductible plan in some representative states:
A: The following states do not have High-Risk Pools as of 2007:
A: The following are some programs that offer prescription drug assistance:
General Programs:
Other programs:
