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If I’m insured now, can I still be declined for a new plan due to a pre-existing condition? Consumer Q&A

By on August 12th, 2011
Filed: Facts, Health Insurance

A few months ago on Yahoo Answers we took a question that I want to highlight today for two reasons. First, it occurs to me that this person’s situation can’t be very rare, though you don’t often hear about it. Second, our answer needs to be updated based on some new rules that the Department of Health and Human Services published recently.

Now, say you live in California, for example, where you have your own health insurance plan. Then, say you are offered a job in Maryland and you want to take this job and move. If you’ve read this blog for a while you’ll know that you probably can’t take your health insurance with you. So, if your new employer isn’t going to give you health insurance benefits, you’ll have to buy a new plan when you get to your new state.

But what if you have a pre-existing medical condition? Does the fact that you’re currently insured help you in any way when it comes to applying for a new plan?

That was roughly the situation in this case. Read the eHealthInsurance reply below (it was voted “Best Answer”) and see if you can guess what part of our answer needs to be updated. I’ll tell you at the end of the post.

Assuming you don’t have any employer-sponsored health insurance available, I’d recommend that you work with a licensed agent. It doesn’t cost anything extra and an agent (online or off) can help you understand your options in a new state. Some insurance companies may be more willing than others to approve your application even with a pre-existing medical condition.

And you’re right – generally speaking, if you can demonstrate continuous creditable coverage (that is, health insurance coverage with a gap of less than 63 days), there should be some kind of option available for you in your new state, though it might not be your dream health insurance plan. You’ll also have to show, however, that you’ve exhausted your COBRA options. Moving to another state may put you in that category, since your old plan (which is what you retain through COBRA) may not have a provider network in your new state.

That’s different from a high risk pool plan, however. And yes, you have to be uninsured for six months or more (and, often, declined by at least one health insurance company) before you can qualify for most high risk pools.

That said, depending on where you’re going to live, you may have other government-sponsored options. Check with the non-profit Foundation for Health Coverage Education (coverageforall.org) to learn more about what’s available in your area.

Did you see the out-of-date information? It’s in the third paragraph. According to new HHS rules, you no longer need to be officially declined for coverage by a health insurance company before you can qualify for coverage under a high risk pool plan (also known as a “PCIP” or pre-existing condition insurance plan). So now you know.

Photo via Flickr user DorkyMum

About Douglas Dalrymple


Doug Dalrymple is a member of the communications team at eHealth, Inc. and has worked in the health insurance and technology industries for fifteen years. He works on communications strategy, content creation and management, project management, and corporate messaging.

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