Medical Insurance
Autoimmune Diseases

Can you get health insurance if you've been diagnosed with lupus?

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Answered 2015-07-15 20:44:52

If you are currently covered under a group health insurance plan through your employer you are eligible to get it through a new employer. However, if you leave your current employer and there is a gap between the time you left and when you start your new one (more than 3 months), the new employer does not have to cover you. If that is the case, you'd be better off going with your Cobra coverage if you quit your present job and when you start the new one you'll be all set.

Correction toI think the three month time frame above is incorrect. I believe HIPAA regulations stipulate 63 days. Do take Cobra to keep the continuous coverage in place as long as you can.

Check with your state health department. Many states make arrangements to cover people who don't qualify with private insurers, usually through some kind of high risk health insurance pool. It's expensive (here in Texas, by law, the rates have to be set 2x higher than the average state rates) but probably not as expensive as a catastrophic illness without any coverage at all. The same pre-existing conditions will likely apply, but if you can COBRA or somehow stay in your insurance plan until you get the state one set up, they'll probably cover everything. If there's a lapse in coverage, the pre-existing conditions apply (at least in Texas).

I have lupus and had lapsed coverage for over a year. Basically, in Florida, I can't get individual coverage. Because some states require that there be a limit to the time a condition can be considered pre-existing by an insurance company, some dread diseases and conditions are flat-out refused for coverage. But I was hired by a company which is part of a PEO (employee leasing group) and because the group is large enough, I didn't have to even fill out a medical questionnaire--the group was already underwritten. So the key may be to be employed by a company with a large enough risk pool that the insurance company does not individually underwrite.

In many cases yes. There are a few states that require insurance companies to offer coverage to everyone (guaranteed issue); New York & Mass for instance. Most employer groups will cover just about everyone so that is an option. Finally there are some plans on the market that have 'almost' guaranteed issue. These are generally high deductible plans with only a few knock-out questions. One plan I use frequently has only three requirements: You must be working, you can not have HIV/AIDS and you can not have had over $25,000 in medical expenses in the previous 12 months.

The Affordable Care Act provides a means for people with pre-existing and chronic conditions to be able to get affordable health insurance. In each state, there is a special fund for this. You can find what is available in your state by going to www.healthcare.gov.

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