It may take searching, and premiums may be higher, but for some patients, choices are available.
Amy Reiley had resigned herself to joining the ranks of the uninsured. The part-time L.A. resident and owner of a boutique cookbook publishing company had a group health insurance plan that for three years covered her and another full-time employee.
But when Reiley's employee became eligible for Medicare, she lost the group policy and was left to search for insurance on her own.
Reiley, in her 30s, has a history of headaches resulting from neck spasms, which she manages with a muscle relaxant. Because of her condition, all her applications for individual health insurance coverage were denied.
"I tried two companies and looked into what the state had to offer and there really wasn't anything I could do," she says.
For people with preexisting medical conditions, looking for medical insurance in the private market may feel like the ultimate fool's errand. A 2009 report by the Commonwealth Fund found that 36% of people who tried to buy insurance in the private market were denied coverage or charged more because of a preexisting condition or had the condition excluded from their coverage. Cancer, heart disease, diabetes, rheumatoid arthritis and drug and alcohol dependency are certain to be automatically rejected by insurers -- and even people who have minor conditions may find the search for an insurance plan tricky.
When the health reform law takes full effect in 2014, health insurance companies will no longer be able to deny coverage to people with preexisting medical conditions. In the meantime, new federally funded high-risk pools for the medically uninsurable have been established. To qualify, you have to be without insurance for six months. And you must show you have applied for, and been denied, insurance in the private market.
But if you have a preexisting condition and don't qualify for the high-risk pools, it still pays to explore options in the private insurance market. Don't assume if one insurer rejects you that they all will. Reiley, for example, did try again, this time with an experienced insurance broker. Although she paid more because of her condition, she found a plan that is cheaper than what she was paying for as a member of a small group.
With proactive steps as well as insight into how insurers decide who they'll cover, you can improve your chances. Insurers also are more likely to cover someone with a clear-cut diagnosis being managed with inexpensive medications rather than a borderline case that may blow up later.