Is It Possible to Get Insurance Coverage If I’m Already in Recovery?

Is It Possible to Get Insurance Coverage If I’m Already in Recovery?

It is now easier for people with pre-existing health conditions to purchase comprehensive health insurance coverage

Many factors influence the price, availability and coverage of health insurance. Historically the existence of pre-existing conditions has made it more difficult or expensive to purchase policies. A series of regulations at both at the state and federal levels have addressed the issue, however, and it is now easier for people with pre-existing health conditions, including a history of addiction treatment, to purchase comprehensive health insurance coverage.

Broadly defined, a pre-existing condition is one that exists before a new insurance policy is to begin covering an applicant. States and insurance companies have used the term in various ways. Some define it as a medical condition for which a patient has received treatment and others include any condition for which symptoms are present, whether or not treatment has been sought. Insurers have addressed pre-existing conditions by charging policyholders higher rates, by excluding treatment of the condition from coverage or in some cases, by denying applicants the option of purchasing policies at all.

Pre-existing conditions have traditionally been important when there has been a lapse in insurance coverage. Lapses can occur for various reasons. Perhaps the most common is that people who receive health insurance through an employer lose their jobs. Lapses can also occur when young adults reach the age at which they can no longer be covered by their parents’ insurance policies or when an insurance company stops operating in a given state or offering a specific type of coverage. Most insurance companies offer a small grace period after an individual loses coverage. If new coverage is purchased or otherwise acquired within that period of time, pre-existing condition exclusions will not apply. The amount of time differs, but thirty days is common.

Laws Regarding Pre-existing Conditions

Through the years state governments have issued a number of regulations regarding pre-existing condition exclusions. Some placed limits on the amount of time that a condition could be excluded from coverage. The limits varied widely from months to years.

One of the first significant federal attempts to address the issue was with the passage of the Health Insurance Portability and Accountability Act (HIPPA) in 1996. The legislation affected group health insurance policies offered through employers. HIPPA provisions prevented insurers from charging higher premiums based on an employee’s medical history or health status. They were also barred from imposing eligibility rules. The regulations applied as long as employees had had previous insurance coverage for a year, with lapses of no more than 62 days. Some states broadened HIPPA applicability to not only employer-sponsored group plans but to self-employed workers as well. .

The most recent and extensive legislation to address the issue of pre-existing conditions is the Affordable Care Act. As the HealthCare.gov website explains, policies sold on the Health Insurance Marketplace are required to cover pre-existing conditions and are not allowed to charge more to do so. This is true even for applicants who have been denied coverage previously.

The website notes, however, that individual policies purchased on or before March 23, 2010 are exempt from the regulations addressing pre-existing conditions. People who do not currently have coverage for pre-existing conditions, such as addiction to drugs like Xanax, can purchase Marketplace plans during open enrollment periods. They may also purchase policies at other times if there are qualifying life events such as a move out of state or changes in family size.

Options for People with Pre-existing Conditions

People worried about pre-existing condition exclusions also have other options. These include the following:

  • COBRA policies – Individuals can avoid lapses and maintain insurance after a job loss by purchasing temporary coverage through COBRA. The United States Department of Labor explains that COBRA policies may be available to those who were covered by group health plans offered by employers with 20 or more employees. They may also be available to those employed by government agencies. The law requires coverage to last for at least 18 months, but it may be possible to purchase coverage for a longer period of time in some cases.
  • Insurers of last resort – Some states offer their citizens the option of purchasing insurance through a designated insurer of last resort. The medical website WebMD notes that policies purchased in this way are likely to be expensive and that applicants must apply within 63 days of losing previous coverage. Designated insurers of last resort must cover all applicants regardless of medical condition or history.
  • Group insurance offered through a union or other membership organization – Although most group health insurance is offered through employers to their employees, it is possible for groups of other types to purchase health insurance together. In 13 states it is also possible for a group of one, a sole employee of a self-owned business, to purchase group health insurance with no pre-existing condition exclusions.
  • High risk pools – The WebMD article notes that 34 states have high-risk pools that offer insurance to people who are otherwise unable to purchase it because of their health conditions.
  • Medicaid – Individuals and families of low to moderate income may be eligible for Medicaid. Medicaid offers coverage regardless of pre-existing health conditions.

Let Us Join Your Team

If you have questions about addiction treatment for drugs like Xanax and insurance coverage, give us a call. If you are looking for a treatment program, we can help you find one that meets your needs. We can also check your insurance coverage for you at no cost or obligation. The call is toll-free, and the helpline is staffed 24 hours a day. Let us join your team.

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