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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Health Insurance for Pre-existing Conditions

By on | 3 Comments

Question: I have been denied insurance due to a pre-existing condition. Are there any insurance companies that will cover me? I have a cyst on my ovary that needs to be removed. I live in California.

Answer: Thanks for your question. It is one of the most commonly asked questions for people applying for health insurance. The answer to the question is fairly complicated. In California, state law mandates that, if an insurance carrier offers you coverage, they must cover all pre-existing conditions. The if an insurance company offers you coverage part is very important here because, if a person is considered to be too high risk, they would be denied coverage - as you yourself have already experienced. In your case, because you have a condition that requires you to have surgery, you would not be eligible for insurance with any insurance carrier at this time. Once you have had the surgery and have a certain period, say six months, where you have been what is called sign, symptom and treatment free, you may be eligible at that time. Which begs the question: what do you do in the meantime? Well, in California there is a major risk program called MRMIP (pronounced Mr Mip). Coverage is expensive but it is guaranteed. It would be worth reviewing your options under this program and perhaps signing up for the plan until you are eligible for individual insurance again. If this is too expensive you may also want to look at Medicaid to see if you are eligible.

In most other states insurance companies have the option to place an exclusion rider on a given condition and issue a policy that covers all other conditions. This is beneficial in the sense that a person can get coverage to cover all other risks including accidents and new illnesses while covering the expenses for the pre-existing conditon out of their own pocket. Once they have been sign, symptom and treatment free of that condition for typically one year (depending on the condition) they can apply to have the exclusion rider removed from the policy.

There is one more thing worth noting: if a health condition is deemed acceptable to an insurance company with California offerings, which is to say it does not represent too high a risk, they will often issue a policy at a higher premium. This may range from between 25-400% over the base premium depending on the condition and the associated medical expenses such as doctor visits and prescription drugs. Once issued, the pre-existing condition would be covered from the effective date unless the person did not have prior insurance coverage in which case there would be a six month waiting period.

3 Comments

Lawrence, That reply was written in 2007. Things have changed since then.

I’m very surprised by your answer. Didn’t Obamacare ban any consideration of a pre-existing condition, at least during open enrollment??

Insurance companies are in the business of making money not helping people

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