Guaranteed acceptance medical insurance is often the only insurance available to individuals with high-risk medical conditions. However, you still need to shop for the best coverage at the best price.
High Risk Medical Conditions
Shopping for health insurance can be frustrating for individuals who have been diagnosed or treated for a pre-existing medical condition. The insurance companies realize that these conditions might require significant medical attention which may end up increasing their costs to pay for the individual's doctor, hospital, prescription and other medical needs. Because of this potential for increased risk, the companies may offer policies with high premiums, reduced coverage or long waiting periods.
There is a wide range of medical situations which the health insurance industry often consider high risk including:
- Heart problems
- Mental health issues such as depression
Some insurance companies will not insure an individual with a high risk medical condition. Other companies will provide coverage but they may charge higher premiums or provide limited coverage.
Shopping for Guaranteed Acceptance Medical Insurance
Guaranteed acceptance medical insurance is available for individuals with pre-existing medical conditions. Coverage options and costs vary between policies, so it is important to shop for the policy that best meets your needs.
Many guaranteed acceptance policies include a waiting period during which you are not covered for expenses incurred due to a pre-existing condition. Typically this waiting period is 12 to 18 months.
If you are changing medical insurance plans because of a job loss or change, the Federal Health Insurance Portability and Accountability Act (HIPAA) can protect you from waiting for coverage of a pre-existing condition. To be eligible for HIPAA protection, the individual:
- Must have had coverage under the prior insurance plan for at least one year
- Can have a maximum break of 63 days between coverage at the first and second insurance plans
This HIPPA protection against waiting periods applies to most insurance plans including:
- Any group plan, HMO or individual insurance policy that is covered by HIPAA
- State-sponsored high-risk medical plans
- Federally-sponsored Medicare and Medicaid
- TriCare insurance for the military
Most states offer guaranteed acceptance to health coverage through a high-risk pool. This pool is usually a non-profit organization that pays for the losses which insurance companies have due to the health expenses of the individuals insured under the state program.The pool programs are different in each state. An individual may be eligible for coverage under a state program if:
- A private health insurance company has denied them coverage due to health reasons.
- They have been offered health insurance that does not cover a pre-existing condition.
- They are being offered insurance with a higher premium because of their pre-existing condition.
Individuals can purchase medical insurance where their acceptance is guaranteed regardless of the pre-existing medical condition. Guaranteed acceptance policies are typically available through insurance brokers.
Insurance companies typically charge higher premiums on guaranteed acceptance policies to offset the increased costs which are anticipated for claims by an individual with a pre-existing condition. Be sure to shop around and compare various levels of coverage. You can minimize your total premium cost with a policy that excludes coverage you don't need (like maternity) while including the coverage you do need (like coverage for pre-existing conditions.)
An insurance broker can be helpful in finding insurance programs that meet your particular needs. Some brokers recommend having two medical insurance policies, which will result in a broader range of coverage. This combining of two policies, called stacking, can be particularly helpful when one policy does not have all the coverage required. For example, a policy with prescription coverage can be "stacked" with a policy that does not have prescription coverage.
There are many medical insurance options available for the individual looking for guaranteed acceptance. The Internet is an excellent source for information on the various programs available. Be sure you understand the coverage, premiums, claims procedures and reliability of a potential insurance company before you make your final decision.