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Bob Howell
Licensed Agent
Unless you are independently wealthy and can pay for your health care out of pocket, health insurance is a crucial purchase. The time to buy it is before you have an accident, suffer a serious illness or discover you're pregnant.
Individual health insurance doesn't cover health care for medical problems or conditions that start before the date you were issued a policy, although there are now Pre-Existing Condition Insurance Plans available from the government. Finding adequate coverage might seem overwhelming, but knowing the basics can help make your search less daunting.
Much of the information below will change in the coming months and years as health reform laws kick in. Here is a health reform timeline of what to expect.
The federal COBRA law (Consolidated Omnibus Reconciliation Act) could provide you with a much-needed short term safety net. COBRA allows workers to keep their group health coverage if they lose their jobs, provided they pay the full premium and a small administrative fee. It applies to those firms with 20 or more workers and generally lasts for 18 months.
Another federal law that offers some protection to workers switching group health plans is HIPAA (Health Insurance Portability and Accountability Act). HIPPA imposes limits on the extent to which some group health plans can exclude coverage for pre-existing conditions. For instance, if you've had "creditable" health insurance for 12 straight months, with no lapse in coverage of 63 days or more, a new group health plan cannot exclude your pre-existing conditions. It must cover your medical problems as soon as you enroll in the plan.
Other ways to buy health insurance when you are between group health plans include short-term health insurance and major medical health insurance.
If you can't buy group health insurance through work, you may be shopping for a private-market health plan. Unlike group plans, in which the costs and risks associated with health care are spread among many people, individual health policies are "medically underwritten" to take into account your personal health history, occupation, age and gender. Any "pre-existing" condition such as heart disease, diabetes and even pregnancy can nix your chances of acceptance or boose your premiums. Some state require individual health insurers to offer everyone a plan regardless of their health conditions, a mandate known as "guaranteed issue". In Texas, it is the Texas Health Insurance Risk Pool.
Once you have individual health plan, don't expect your premiums to remain sthe same. Health insurance companies often seek permission to raise premiums. Additionally, some state allow health insurers to "file and use" rate increases, which means the insurers only have to submit their increases in writing and then they may immediately begin charging more. Unless state regulators determine the rates are excessive, the insurers are allowed to keep charging the higher premiums.