How to Get Private Insurance if You Have a Pre-Existing Condition
Posted by Sarah at 7:26 pm in Health

If you need to purchase private health insurance and you have a pre-existing medical condition, there are just two words for you – comparison shopping.

Pre-existing conditions are important in the process of underwriting insurance, as this is how an insurance company determines how much risk an individual poses.  Each policy or group of policies can only accommodate so much risk.  Too much risk, and there’s the possibility that too many claims could be filed that it would bankrupt the reserves for that policy.  Lower risk means that premiums can be lower and the cost savings can be passed along to the customers.  However, as someone who’s shopping for private insurance, expect to pay more overall for your policy.

If you’re shopping for private insurance and you have a pre-existing condition, you’ll find that some insurers will cover you and others won’t.  Again, this depends primarily on the underwriting guidelines for each company and policy.  An independent agent who represents a number of companies may have an easier time helping you find some options than an agent who works with a single company.  You should plan to talk with several companies and agencies to find the best deal for you.

But first, a word of caution.  You may be tempted to avoid telling a prospective insurer about any pre-existing conditions you have.  This is a very bad idea.  Lying on an insurance application is insurance fraud.  Furthermore, if it’s determined that you lied on your insurance application, your coverage will be canceled and you may have to pay back any amounts that have been paid out on your behalf.  When it comes to insurance applications, honest isn’t merely the best policy – it’s the only one you should follow.

If you have a pre-existing condition and you’re switching to private insurance from a plan you’ve had through work, obtain insurance as quickly as you can.  If there’s no gap in your coverage, your pre-existing condition may be covered.  You also have the option to extend the coverage you had through work under the COBRA program.  This can be expensive – less so than it used to be – but may be a good choice for you until you can secure other insurance.  And currently, if you were fired or laid off from your job, you may qualify for a government subsidy that will pay 65% of your COBRA premiums.

Unless a medical condition is an absolute bar to coverage, you may find a policy that will cover you for all conditions except the pre-existing condition, but will provide coverage for the pre-existing condition after a certain period of time has elapsed.  If you find more than one such policy, compare them carefully to see which is the better deal.

In addition, if you have a pre-existing condition, you may have better luck finding private insurance if you belong to a group.  The more insured people that the risk is spread across, the lower your premiums will be and the greater the likelihood that you may be accepted.

If you’ve worked with a number of agencies and insurance companies and haven’t been able to find any insurance coverage, you aren’t completely without options.  Some companies offer discount plans that can get you reduced rates for doctor’s visits and medications when you choose providers within a specific network.  Although this isn’t full insurance, it can mean a substantial savings over having to pay for these things out of your own pocket.

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