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eLearning Series:
Your Most Popular Insurance Questions
Answers For Health and Home
Insurance
( 50 articles
in this series )
Health Insurance
If You Have Special Needs
More than 40 million Americans do not have
any kind of health insurance protection, and as a result, are
at risk of either not receiving the level of care they should
have, or alternately receiving the care and the massive bill
that accompanies it.
Having adequate health care insurance, whether public or private,
in place plays an essential role in making sure medical care
is accessible to all Americans. This is especially
true for adults and children with special needs, because of the increased
requirement for specialized and expensive services that typically
accompany special needs conditions. More frequent medical treatment,
therapy and adaptive equipment can quickly devour the budget
of even an affluent family with a member with special needs,
making health insurance a necessity.
However, when it comes to special needs insurance coverage,
it is wise to ensure your policy addresses the extended
parameters of special needs care including more frequent doctor visits,
greater need for surgery and physical and emotional therapy,
expensive prescription medicines, custom equipment, home care,
assisted living or nursing home facilities. Securing an all-encompassing
policy can be a daunting task, particularly if you are opting
to purchase a private plan. Recognizing that individuals with
special needs may require extra expenses, many private insurance
companies put extreme limitations on ‘addition’ or above-standard
services. When it comes to trying to secure health insurance
as an individual with special needs, there is no guarantee
you will even be approved: nearly all private health care insurance
providers enact stringent rules on what is covered and what
isn’t allowed. You will likely find that your special needs
fall under the category of pre-existing conditions, and you
will not be eligible for coverage of health expenses related
to those pre-existing conditions. If your application is accepted
and your special requirements are covered by the insurance
plan, you can count on very high premiums. Do research when
looking at private health care insurance options and don’t
be afraid to ask questions about your specific needs. It is
better to have reliable information ahead of time rather than
to discover your insurance company will not support you later
when you need it.
Employer-sponsored
insurance (ESI) is by far the most popular choice of health
care insurance for adults, whether fully able
or with special needs. If you receive a health benefits package
as part of your employment, you will be accepted under the
company’s plan regardless of your health status. However, when
you apply for individual coverage, there are no such guarantees
and, as described above, you many not be able to secure the
coverage you need, even with high premiums or reduced benefits.
The same is true when it comes to renewing your health care
insurance: if your covered under your company’s EIS medical
plan, you can renew your coverage as necessary, even if you
are sick. With most individual plans, there is no guarantee
your policy will not be cancelled.
There are also differences for people with special needs to
consider between job-based and individual-based insurance when
it comes to limitations and portability. If you have had a
pre-existing condition when you apply for job-based medical
coverage, there is a limit of about a year to a year and a
half on what can be counted ‘against’ you. With individual
coverage, limitations are prescribed by the state, and vary
greatly state-to-state, but generally, you may not be eligible
for coverage of costs related to a pre-existing medical condition
for the entire duration of your policy.
When it comes to portability, again, depending
on the state in which you reside, it is possible that you
may receive no
credit for past coverage. That means even if you are lucky
enough to qualify for health insurance coverage, you could
end up waiting for the entire pre-existing condition exclusion
period.
If you have special needs, your best bet may be to see if
you qualify for Medicaid or Medicare. More than half of the
states operate ‘high-risk pools’ health care insurance plans
for people with special needs who, because of their conditions,
are unable to secure medical insurance through regular channels.
Information about these high-risk pools, and to see if you
qualify for coverage under your state’s program can be found
under the National Association of Health Underwriters’ website.
Click here to to view health insurance quotes, compare plans side-by-side and apply for the most affordable health insurance within your budget. I did this myself (June 17, 2011) to change my health insurance policy. Saved me $84 per month (or $1,008 per year). It's my SolveYourProblem recommendation.
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by SolveYourProblem.com : 2005
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