People are HIPAA-eligible and are guaranteed the right to purchase some form of individual insurance coverage without pre-existing condition exclusions under HIPAA if they meet the following criteria:
1) they have had at least 18 months of previous health insurance coverage without a break in coverage lasting 63 days or more;
2) their most recent period of coverage was under an employer-sponsored group plan, a church plan, or a government plan;
3) they did not lose insurance coverage due to fraud or failure to pay premiums;
4) they are ineligible for or have exhausted their COBRA coverage options or similar state continuation coverage; and
5) they are not eligible for any other employer-sponsored group plan, Medicaid, or Medicare.
If you can say yes to all of these, you are HIPAA-eligible and are guaranteed the right to purchase some form of individual insurance coverage without pre-existing condition exclusions.
What prevents most people from becoming HIPAA-eligible is that they don't elect COBRA, usually because of the cost; however, with the recent COBRA subsidies offered by the government, cost has been reduced to 35% of the monthly premium. Income requirements for subsidy eligibility are a single person income not exceeding $125,000, or $250,000 for married individuals filing jointly.
The first subsidy offered last year was for 9 months, and a 6 month addition was passed in January of this year. That gave most who were laid-off last year 15 months of COBRA at a reduced premium of 35%. Federal COBRA has a limit of 18 months. An additional 3 - 18 months of state COBRA benefits may be available.
With so many still unemployed and since more have elected COBRA, in the upcoming months many will see their their benefits end. If there are no additional state COBRA benefits, then they will qualify for a HIPAA-eligible plan, provided they can answer yes to the other 4 criteria. People who exhaust their COBRA benefits, or who did not get any because their company went out of business (no more company, no more group plan, no COBRA), may not know they can get medical coverage with a pre-existing condition that is not a group plan.
Protections You Have as a HIPAA-eligible Individual:
• All insurers who offer individual coverage must offer you a choice of at least two policies.
• There is no pre-existing condition exclusionary period.
Premiums will be higher than regular plans and you will not have a full range of plans to choose from. You should be able to find online the plans, benefits and premiums available in your state by searching HIPAA eligible plans and the state you live in.
Some useful Web sites:
http://www.familiesusa.org/issues/private-insurance/legal-rights/hipaa-definitions.html http://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/protect.pdf
Luana
1) they have had at least 18 months of previous health insurance coverage without a break in coverage lasting 63 days or more;
2) their most recent period of coverage was under an employer-sponsored group plan, a church plan, or a government plan;
3) they did not lose insurance coverage due to fraud or failure to pay premiums;
4) they are ineligible for or have exhausted their COBRA coverage options or similar state continuation coverage; and
5) they are not eligible for any other employer-sponsored group plan, Medicaid, or Medicare.
If you can say yes to all of these, you are HIPAA-eligible and are guaranteed the right to purchase some form of individual insurance coverage without pre-existing condition exclusions.
What prevents most people from becoming HIPAA-eligible is that they don't elect COBRA, usually because of the cost; however, with the recent COBRA subsidies offered by the government, cost has been reduced to 35% of the monthly premium. Income requirements for subsidy eligibility are a single person income not exceeding $125,000, or $250,000 for married individuals filing jointly.
The first subsidy offered last year was for 9 months, and a 6 month addition was passed in January of this year. That gave most who were laid-off last year 15 months of COBRA at a reduced premium of 35%. Federal COBRA has a limit of 18 months. An additional 3 - 18 months of state COBRA benefits may be available.
With so many still unemployed and since more have elected COBRA, in the upcoming months many will see their their benefits end. If there are no additional state COBRA benefits, then they will qualify for a HIPAA-eligible plan, provided they can answer yes to the other 4 criteria. People who exhaust their COBRA benefits, or who did not get any because their company went out of business (no more company, no more group plan, no COBRA), may not know they can get medical coverage with a pre-existing condition that is not a group plan.
Protections You Have as a HIPAA-eligible Individual:
• All insurers who offer individual coverage must offer you a choice of at least two policies.
• There is no pre-existing condition exclusionary period.
Premiums will be higher than regular plans and you will not have a full range of plans to choose from. You should be able to find online the plans, benefits and premiums available in your state by searching HIPAA eligible plans and the state you live in.
Some useful Web sites:
http://www.familiesusa.org/issues/private-insurance/legal-rights/hipaa-definitions.html http://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/protect.pdf
Luana
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