Question: I’m 21 years old and out of college, making 50k a year and I also receive health care thru my employer. My father has no insurance and makes 35k. My younger sister lives overseas but she will be moving here to nj as she cannot live with my grandmother anymore. We are permanent residents living here 5+ years, my father 10+. My sister is 16, she has epilepsy, ADD and depression. She needs constant check ups with theneurologist, psychaitry and daily medication. Is it possible to add her under my employers insurance (horizon hmo)? If not what other options do we have based on our income? Thanks in advance!

*Answer: * No. You cannot add her to your group plan. But your sister should move to New Jersey as soon as possible, because NJ is one of the few states that have guaranteed-issue individual health insurance. What that means to her is that she can buy health insurance from any insurance company in NJ at the same rate as her healthy neighbor.

Question: As of right now I am on my dad’s insurance through his work. I lose coverage on Oct. 27th (my 26th birthday).I am also 5/6 weeks pregnant. No insurance will cover me and my husband. What can I do for coverage once mine drops at the end of this month?

Answer: As you know now, you can’t buy private health insurance once you are pregnant. But many states have resources for exactly your situation. Some state programs are for low-income moms and some not. Worth at try. Start your search at coverageforall.org, enter your ZIP code and go.

Question: My employer is telling me that my 16 year old daughter’s baby will not be able to be covered under my insurance plan because it isn’t MY child. However, the state is telling me that if I make too much, they can’t enroll the child on state coverage. How am I supposed to make sure the new baby is covered by insurance?

Answer: You will have to purchase child-only individual health insurance for your grandchild.

Question: I am getting medical coverage from my husband’s work. He is going to retire and I am not at retirement age yet. As I understand, he will start getting medical coverage through Medicare. 1. What is going to happen to my med coverage? 2. What if I have “pre-existing conditions”?

Answer: When your husband retires, your family’s health insurance coverage will end. He will be covered by Medicare (if he is 65 years old or disabled). You will have to purchase your own health insurance and I understand you may not qualify for individual health insurance because you have preexisting medical conditions. If you are declined individual health coverage, you will qualify for guaranteed issue health insurance coverage under the federal HIPAA law. Most health insurance companies who market individual health insurance offer HIPAA qualified coverage. HIPAA plans are usually high deductible PPO plans at a substantial mark-up over the standard rate for a “healthy” applicant. The idea being that HIPAA applicants are a greater risk as a group. You may be able to purchase a HIPAA plan from your current insurer, but can shop for HIPAA plans from any other carrier in your state. A second option may be available - major-risk pool health insurance. Availability varies by state.

Question: How much more can a health insurance carrier charge versus quote on internet?

Answer: All health insurance companies who offer individual health insurance must work off a published price list for individual health insurance rates. So the internet rate is the published rate - the lowest rate you can get. During the underwriting process, a risk or a grouping of risks, for example overweight and elevated cholesterol, may cause the underwriter to “rate-up” the applicant. The amount that the insurance company can rate-up the applicant varies among states. but it can be as much as much as 300% in some states. In that case the carrier is saying, “we’d rather not cover you, but if we must, you’re going to have to pay through the nose. Thankfully, this BS goes away in 16 months with health reform.

Question: We live in PA. In 2010 my husband left his last job and went out on his own as a painting contractor. We shopped for health ins and were told we could no longer get covg as a sole proprietor as we had in the past in that situation. We now had to become an LLC and then they had to have my husband on one plan on his own and me as an “employee” on another plan w/our daughter. We all have pre-existing conditions. I alone had a heart attack w/stents placed in 2009 and we all 3 take about a total of 15 rx meds. Our total ins premiums right now through KHPE are over $1800 per month. That’s 1 1/2 times our mortgage. We can barely make these payments each month and are trying to figure out if there’s something better out there for us. Starting to feel really hopeless.

Answer: There is hope, but not immediately. If you can make those premium payments for another 16 months, you will be off the hook. In January 2014, you will able to purchase individual health insurance form the State Health Insurance Exchange in PA. Rates will be the same for all regardless of health conditions. In addition, federal subsidies will greatly reduce your premium. Hang in there. It’s not hopeless.

Question: I had medical insurance until 7/31/2012 through my mother’s group plan coverage, when it expired due to the fact that I graduated form college. Before that coverage expired I applied at a different medical insurance plan but was denied due to a pre-existing condition (Chron’s). Can I be denied even if I am insured or have been during the preceding six months?

Answer: Yes. You can be denied for individual coverage for preexisting conditions regardless of your previous coverage. Chron’s Disease is a denial condition for all the individual health insurance underwriting guidelines that I know about.

However, (and here’s where you need to pay attention) the fact that you graduated from college is not a reason to be dropped from your parents coverage. You can stay covered on your mother’s health insurance until age 26. If you are not yet 26, have you mother reinstate you on her insurance right away.

Question: Can i cancel cobra and keep my wife covered under cobra who has a preexisting condition?

Answer: The former employee (husband in this case) must be covered under COBRA continuation coverage in order for any dependent to be COBRA covered. If you wife has been without coverage fro 6 months or more, PCIP coverage is another option.

Question: I had health insurance coverage on my son when I was working for 2 years. In March I resigned from my job… filled out paperwork (to be added to father’s group coverage) on 6/30. The HR Department said that he will not be added to the insurance until the 1st of the year. Everyone is telling me that he should qualify for “special elections” and there is no time limit on that. Is this true? I think the employer is trying to say we waited too long to add him to his dad’s insurance.

Answer: Yes, apparently you did wait too long. You may enroll a dependent during the period beginning 31 days before and ending 60 days after a qualifying event (in this case the end of your employer-sponsored coverage - probably March 31). That would make May 31 the deadline adding to his father’s plan

You mentioned that your son has preexisting conditions. When he has been without health insurance for 6 months, he can apply for coverage in the Preexisting Conditions Insurance Plan (PCIP). unless there is another event during this time that would permit an enrollment change).

Question: My daughter who is 23 and is a covered dependent on my husband’s insurance policy is pregnant and Maternity is excluded on the policy. My question is that in California Maternity Benefits are now mandatory as of July 1, 2012. Would this apply to her as well? If so, who do I contact to get her covered? Thanks so much!

Answer: Yes. Maternity coverage is a mandated benefit in California on new plans issued after July 1, 2012. However, your husband’s coverage was issued prior to that date. It does not automatically include maternity coverage now. If his coverage is part of an employer sponsored group health insurance plan, maternity coverage will be included at open enrollment, when the entire group renews or moves to a new plan. If your husband’s coverage is an individual plan, he would have to reapply for a new plan effective July 1 or later and go through the underwriting process. Your daughter’s pregnancy is a preexisting condition that will result in the application being rejected. I’m afraid there is no way your daughter’s prenatal and normal delivery expenses can be covered now. However, her current policy will cover medical complications during pregnancy and delivery should that occur.

Question: I was laid off - my medical coverage ended on 3/31/2012. I did not elect cobra. I purchased a high deductible, no prescription coverage, bare bones health insurance policy that begain on 6/1/2012. On 6/14 I was diagnosed with multiple Sclerosis. I am a Pennsylvania Resident. I have a meeting with an Attorney to start filing for disability, but this could take a year or more and possible denial. What is my best option to obtain better coverage at this point, so I’m not buried medical expenses?

Answer: You cannot improve your health insurance coverage at this point. On the plus side, you do have coverage and help is coming. Assuming the Affordable Care Act stays in force, you will be able to upgrade your coverage on January 1, 2014. With MS, the big out-of-pocket expense for you will be prescription drugs. Please read this article 7 Ways to Cheaper Drugs.

Question: Would like to quit my job because my mom is ill and need to take care of her. I have bone on bone with both knees and will need surgery down the road. I have been having steroid injections for the past 2 years and have been very helpful. My husband is planning on putting me on his plan what complications do you think we will have with getting me coverage?

Answer: If your husband’s health plan is a group health insurance plan. You will be able to be added to his plan on the month following your employment termination. Your loss of employer-sponsored group health insurance is a qualifying event that will enable your husband’s plan to pick you up without having to wait for his plan’s open enrollment period. If your husband’s health plan is individual health insurance, you will probably be declined. That will leave COBRA coverage as your next option.

Question: After applying for a medical plan and being accepted, then one month later having heart trouble - will policy pay?

Answer: If the insurance company can determine that your heart condition was pre-existing, they will not pay. They will look at your application with a microscope. For example this is the type of general question that should uncover a pre-existing condition.

• “Within the last 5 years have you been advised by a healthcare provider to have, but have not yet had, surgery, treatment, examination, evaluation or test(s) for a medical condition?”

If the insurer can produce medical records or claims history that shows that you did not answer accurately, they will deny your medical claim and rescind your insurance - even if your oversight was not related to a heart condition.

Question: I am a 57 yr old underweight female with a history of controlled asthma and allergies who is mostly healthy. Because of these risk factors, I want to know if underwriting success is higher for a high deductible/low premium plan vs a low deductible/high premium plan. I want to apply for plans with the lowest risk of being declined.

Answer: Generally, the probability of being accepted for coverage is improved by choosing a higher deductible plan. There are some variations to the risk assessment with every carrier. The frequency and number of prescriptions, along with any other risk factors will affect the final underwriting decision regardless of the chosen deductible. I suggest, you call our individual underwriting specialist, Erin, at 800-557-5693 and go over your medical history with her. She can determine where you will be treated the most favorably.

Question: If i am terminated from my job and have to go onto my husbands insurance will my cancer diagnosis be considered pre existing?

Answer: Your cancer diagnosis is a pre-existing condition for any insurance you would apply for going forward. If your husband’s coverage is group health insurance, your pre-existing condition will not prevent you from becoming insured on his plan. If his coverage is individual health insurance then your cancer diagnosis will cause you to be denied coverage. If that is the case, you have 2 other options COBRA and HIPAA health insurance coverage.

Question: My husband voluntarily left his job and was offered COBRA for both of us. I am employed by a different company and now want to apply for their health insurance, when do I qualify for coverage. Do I have to wait until the Cobra enrollment period (65 days) runs out?

Answer: Your loss of health insurance due to your husband’s termination of employment is considered a “qualifying event” which allows you to join your own employer’s group health plan on the first of the month after loss of your husband’s coverage. COBRA is an option for people who do not have another employer-sposored option as you do.

Question: Can grandparents cover a baby with insurance?

Answer: If you mean, can you add your grandchild to your individual or group health insurance coverage the answer is no unless you are the child’s legal guardian. You certainly can purchase individual coverage for your grandchild - referred to as child-only health insurance. Unfortunately, due to the law of unintended consequences, child-only coverage is impossible to get in most states. The Affordable Care Act (ACA) legislated that no exclusions of coverage would be allowed for children through age 18. The intent of the law was to make health insurance for children guaranteed-issue - meaning they can’t be turned down because of pre-existing conditions.In most states child-only health insurance is no longer available (California being one of the exceptions) because the insurers refuse to comply with the law’s intent. Quite possible, this stalemate will continue until January 2014, when all health insurance is guaranteed issue.

Question: I’m 9.5 months pregnant and currently covered under my husband’s group insurance policy. It’s very expensive, but we obviously needed the maternity coverage, so we opted for adding me to his rather than me getting individual insurance. We’d planned on just adding the baby to our plan, but just found out that the cost of this with our current plan is prohibitive and we can’t downgrade the plan for another 9 months (during open enrollment). I have done some research and think the best bet is for him to drop me from his plan 1 month after the baby is born (so my postnatal visits are covered) and for me and the baby to get individual insurance (which is still substantially cheaper than the family plan through his work) as soon as she’s born. My question is about the timeline with the birth and insurance. Since we wouldn’t be adding the baby to our existing plan and instead starting a new plan (which it looks like I can’t do till she’s born and we have her birth certificate), will we have trouble getting coverage? I know we have 30 days to add her to our group plan, but if we’re opening up a new plan, how does that work? I know it can take up to a few months to get new coverage and obviously can’t go without coverage for my child. We’re in Florida and I have no health concerns (other than currently being pregnant!). I’m nervous since we don’t have much time to sort this out. Thanks for your help!

Answer: I’m guessing at 9.5 months pregnant you don’t have much patience for a long-winded answer so I’ll get right to the point. You can apply for individual health insurance - both you and the child together - about 2 weeks after the baby is born. You will need a copy of the initial physical exam for the baby. If the baby has no health issues, you should be able to get coverage starting within 30 days of the baby’s birth. Your group health insurance will cover the baby for the first 30 days after birth. If you have the energy, click here to start shopping for a health plan now - just enter a birth date of a month ago for your child.

Question: My husbands insurance was cancelled for the year because he did not have enough hours due to unemployment. What can we do for insurance. His union is offering us coverage for $7000. we can’t afford that! We are hoping to stay healthy and get through the year. Any advice?

Answer: Staying healthy will definitely make thing easier, but if you need medical care, here are some other ideas:

1. Check out your local free clinic (if you are lucky enough to have one in your area). Generally, there is little paperwork and good doctors, dentists, and nurses who volunteer their time.
2. Read my article, 7 Ways to Pay Less for Hospital Care
3. Read Maggie’s article, 7 Ways to Get Cheaper Prescription Drugs

Good luck.

Question: I am 9 weeks pregnant and recently qualified for PCIP (for people with pre existing conditions without insurance 6 months). It is ONLY maternity coverage. Coming up in February, I am eligible for my work health insurance to kick in. I am confused. Can I keep my maternity with PCIP and enroll in work (anthem blue cross for Dental, vision, and medical come February? I am concerned because before applying for PCIP, I turned to anthem and they denied me because it was a pre-existing condition. Can I have both insurances? Please help. Thank you.

Answer: You are very fortunate to be pregnant and have 2 options for coverage. Let me start by saying that you can’t have both PCIP and employer-sponsored group health insurance. You need not be concerned about selecting the employer-based coverage with Anthem Blue Cross as you cannot be declined due to preexisting conditions with group health insurance as you were when applying for individual health insurance.

Question: I have a pre existing condition and my health insurance has gone up considerably every year. We now pay over $2000 a month and I'm 32 years old. I have 3 questions: (1) I'm thinking of moving from New York to California- can I keep my Aetna plan and stay insured even though I'm moving states or can they drop me? (2) The other question is I'm getting married and would hope that I could join my husbands plan however would they accept me with a pre existing condition? (3) And will Obama's law help me in any way? Thank you.

Answer:

(1) You must have a group or employer-sponsored health plan as Aetna not sell individual plans in NY. If you remain employed with the same employer and move to another state, you can continue with Aetna group coverage and they cannot drop you.

(2) If you get married, you can be added to your husband's health insurance plan without consideration of your preexisting condition if you remain in NY state as NY has guaranteed issue laws albeit at very high rates as you point out, If you move to California (married or not) and apply for an individual health insurance plan, you will have to qualify through the underwriting process and your preexisting condition may cause you to be declined for coverage.

(3) The main provisions of the Affordable Care Act (what you referred to as Obama's law) are scheduled to go into effect in January 2014. Insurance companies in every state will not be able to use preexisting medical conditions to deny coverage or charge more for coverage. That would pretty much solve both issues you raised above. You will then be able to buy an affordable health insurance plan anywhere in the country. So, yes, I would say it will help you big time.

Question: If a medical condition was over 15 years ago, is it considered pre-existing?

Answer: The underwriting guidelines for most individual health insurance carriers will usually draw the line for serious preexisting conditions at 10 years. That is to say, if you’ve had no treatment or symptoms for that previous condition in over 10 years, that previous condition will not cause your application to be declined automatically. However, your overall health risks will be evaluated, however you could still be refused coverage. The outcomes of individual health insurance underwriting are very difficult to predict right now.

Many questions continue to come in about covering young adults to age 26 on their parents' health insurance coverage. Officially, the regulations governing this issue go into affect on September 23rd, 2010. I've taken the liberty of including an excellent Q&A page from the U.S. Department of Health & Human Services website - www.hhs.gov. It's very comprehensive and covers all the bases.

Question: I'm male, age 63. I had bariatric surgery. COBRA recently ran out. Applied to several reputable insurance companies, most won't insure us and those who will want $800+ per month. I don't understand underwriters adversity to bariatric surgery whereby I lost 100 lbs. and got rid of my diabetes and medical insurance paid for it. Looking for affordable Major Medical and I can afford to pay $400.

Question: My husband has been offered a job with a good company.They have offered to pay for cobra for the 90 day waiting period until his new insurance kicks in. My question is, my husband is in pain managment where he gets steriod shots and is administered medications from a previous back surgery over a year ago. I myself have high blood pressure.This new insurance company United Health Care, has told me that he must be evaluated by the underwriters to see if they will cover these preexisting conditions,if he denied we will be out of luck. Is there anything that we can do, or any resouce that we can contact to get information. Thank You

Question: I'm 21, and just moved out of state and am not on my moms health insurance anymore because im taking a semester off school. Is there anyway I can get health insurance so I can afford cheaper birthcontrol?

Two questions: I had a sarcoma cancer removed 7 yrs. ago and have tried to get life insurance (additional to my small policy with my employer) but have been denied. Will I ever be insurable? I'm a state employee of 20+ yrs. with 2 children and the possiblity of a layoff, which would cancel my current health and life insurance. Would we as a family (children & husband) be eligible for health insurance? And would we be required to have physicals as I did with the life insurance application? Thank you...

Question: BCBS of Illinois only covers dependent children until 19 years of age. I need to find health coverage with bi-polar, personality disorder, PTS and takes meds. She currently is not employeed.

Question: my question is bcuz of my weight which I have no health problems. I was denied health insurance. Thank you Tina

Question: My daughter was covered under my health insurance until she turned 23 years old. I elected to buy Cobra, hoping that she would eventually get insurance when she graduated from college & found a job. She is working full-time for the federal government, but doesn't receive health benefits (she is considered a seasonal employee). Because Cobra is so expensive, I contacted PacifiCare directly for insurance. (We signed up with Cobra and simply continued with PacifiCare as the provider).
She was just denied coverage because she has been taking Lexapro since she was a teenager. I never that it would be an issue. She saw a psychiatrist 5 times when she was 17 years old. The psychiatrist told me that my daughter has a chemical imbalance and may need to always take meds to regulate the imbalance. My daughter is not bio-polar or suicidal. She graduated cum laude from college and has an active social life. As I said, I never thought in this day and age a drug for depression would keep her from obtaining insurance. Is it considered a pre-existing condition even though she has been covered by PacifiCare for 10 years? (The last 1 ½ years through Cobra, but her health carrier is PacifiCare).
Would it have been better for her to lie and cover the drug expense herself? I know you don't recommend lying, but what will happen in the future if she is offered employment? She is being responsible and taking care of a chemical imbalance and yet she'll be penalized for being truthful.

Question: What are the guidelines for privacy when applying? Is information submitted for application of Insurance protected?

Question: I recently applied and was declined for a condition that I have had for over 10 years and that no underlying cause has been found. When the condition does occur, which could happen once or twice in a year or not at all, the prescription used is of minimal cost. Should I appeal the decline?
Thank you.

Question: I'm looking around for another plan because my insurance company keeps raising th e price - twice this year already and I have not cost them a dime! Is there a company out there who recognizes a good customer when it sees one?

Question: I have an application for United Healthcare and it's asking for so much information that I'm way overwhelmed. What do I include and what do I leave off? I'm completely healthy other than I'm taking HRT meds for hot flashes. I had a summer cold last year but I'm not sure of the date - do these two things need to be on there? Their asking for 10 years back.

Question: My wife and I are in the process of adopting a baby girl from China.We live in Escondido, California. We need to get her some health insurance but the application form for Blue Cross is asking for all kinds of information we just don't have. We don't even know her height and weight at this point! What do you suggest?

Question: I need health insurance but I dont know if I can get it because I have a couple of health issues and you know how insurance companies are. Is it ok to put applications in with a couple of companies at the same time?

Question: How long will it take for my application to go through? I did it online a few day's ago and need coverage to start on the 1st of next month.

Question: I live in Florida and I'm moving with my wife and two sons to Colorado when I start my new job in September. My new employer doesn't offer benefits so I need to get my own insurance. I don't want to be without insurance. My question is how can I get insurance in Colorado when I'm still living in Florida?

Question: I applied for health insurance with Unicare and they turned around and told me they couldn't cover me. Can they do this? I was covered with them for years through my employer and paid them thousands of dollars in premiums. I only have a little acid reflux and use one prescription called Nexium!! Are they allowed to do this? How do I get them to change their minds about this?

Question: I work for a small company that doesnt have benefits like health insurance so my employer will be paying. When I called Unicare and they told me that I couldnt have health insurance with them if my employer is paying for it. Why??? Is there another company out there that will cover me?

Question: I was declined insurance and they said it was because of a previous claim that I made while I had employer coverage with the same insurance company. I called them to find out why and they said I was treated for high cholesterol while I had the group plan. I have never had high cholesterol, in fact I'm completely healthy!!! What do you think I should do about this?

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.