Updated
Options for the Uninsurable
Things have changed quite a bit
since 9/23/2010 in terms of options
available for people who are unable
to qualify based on health so it's
probably time for a refresher what
what's available on the California
health insurance market. The
landscape is always changing with
2014 being the dramatic market shift
but let's address what's available
until then.
So let's start with situation where
you are unable to qualify for
individual/family insurance doe to
pre-existing health issues. We'll
walk you through the options the we
usually would on the phone with a
client or visitor to the site.
People who need coverage usually
fall into three categories. They
are either losing group coverage or
exhausting Cobra (which is
continuation of group health
insurance); moving to the State from
another State and need to purchase
California health coverage; and/or
they have been uninsured for some
time. The scenario you fall in can
affect which way to go.
Let's first look at the Cobra/Group
group of people. First, let's say
that you should never lose your
Cobra or Group option until you have
confirmation of approval with
another adequate plan. Do not
assume you can qualify and cancel or
lose Cobra. You typically have 62
days to elect Cobra from your last
date of group health insurance.
After that 62 days, the Cobra option
disappears. At the end of Cobra,
you may have another 18 months
called a Cal-Cobra extension. Check
with your HR department or carrier
to see if there's a Cal-Cobra
extension. This would usually take
you 36 months out in terms of total
Cobra. Keep in mind that Cobra only
exists if the group plan exists. If
the company shuts down or closes the
group plan (not replace but shuts
down), then Cobra also goes away.
Cobra is usually expensive so most
people try to avoid it but you don't
want to lose the option. Either
secure other health insurance first
or at least get back the declination
before the 62 day window. If you're
exhausting Cobra or in certain
cases, losing Cobra involuntarily
(as in company closing example
above), you may have a HIPAA option
with also has the 62 day window
(from last date of Cobra or group
coverage if shutting down). There
are some other requirements but our
main message is not to lose these
options.
What if you had coverage and are
moving to the State but are unable
to qualify for California health
insurance? That's a little
trickier. Check to see if your
prior health carrier as any kind of
transfer option or plan. Some
Anthem carriers in other states have
these set-ups. Health insurance is
still State by State which can make
things difficult when you move
across borders. There is still
MRMIP through the State if you have
had coverage in the last 6 months.
MRMIP typically has a waiting period
so check out the site to see where
that stands. It's not cheap but it
can be guaranteed issue if you
qualify. Qualification is not based
on income. On the same website as
MRMIP is AIM which is coverage
specific to uninsured pregnant women
and their newborn baby. It is based
on income but between AIM and MRMIP,
you have some options to look at.
The reason we mentioned being
insured within last 6 months is the
kid on the block, PCIP. This is the
new Federal program for the
uninsured with pre-existing
conditions. The main catch is that
you have to have been uninsured for
past 6 months. The premiums are
relatively reasonable so if you are
uninsured for past 6 months, this
would be our first option.
Group coverage in
California is guaranteed issue so if
an employer offers coverage, make
sure to take advantage of this
option. Of course, everyone's
scenario is different. We would be
happy to help go through your
particular circumstance to help you
navigate the various California
health insurance options available