Health Insurance Specialists - Guide for the Uninsured and those having difficulty obtaining health care coverage, those with Pre-Existing Conditions, etc..

Following is a helpful guide to those who find themselves uninsured for these reasons. This gives you several options to explore, in decreasing order, with the most viable option listed first. The guide covers topics such as:

Employer Group plans, including
- Very favorable underwriting rules
- Reduction or elimination of the Pre-existing conditions waiting period if you have had prior health insurance, and meet other qualifications. This is HIPAA (Certificate of Creditable Coverage) Portability.
- New Group plans, even for businesses with 1 or 2 employees, which cannot deny you coverage
COBRA continuation of coverage
Retirement Coverage and Conversion
Guaranteed acceptance into an Individual / Family plan, with no pre-existing conditions waiting period if you meet the qualifications for HIPAA (Guaranteed Issue) Portability
Individual / Family plans that are medically underwritten, but for which you may qualify
Hints for lowering your premium
Short-Term (Temporary) Health plans that are inexpensive & easy to apply for
Governmental Healthcare or Social Services, including
- KidsCare
- AHCCCS (for the State of Arizona)
- Maricopa County Health Services
Medical Discount Programs and Limited Benefit plans, including
- Care Entree
- Various Networks of Providers, that give you the same discounts enjoyed by health insurance plans

I have medical conditions, and I was turned down for health insurance

If you have a medical condition, there are 2 main issues to be concerned about:

Underwriting - the process of approving your application for insurance, denying coverage, or giving you a "modified" offer (a "modified" offer may be a premium rate-up or exclusion rider). Enrollment in some plans (such as in-force Group Plans & Portability plans) do not require medical underwriting before you are approved.
Pre-existing Conditions Waiting Period - Even if you are fully approved in the Underwriting process, there may be a waiting period for Pre-Existing Conditions (most commonly, about one-year). Some plans, such as HMO's, do not have waiting periods for Pre-Existing Conditions. Click here for a brief explanation of common pre-existing conditions clauses.

Also, you should become knowledgeable about the laws that give you rights to coverage (such as COBRA, Conversion, and HIPAA Portability). There are two Portability categories.

One is for those enrolling in Group Plans (known as HIPAA "Certificate of Creditable Coverage" Portability)
The other is for those enrolling in an Individual / Family Plan (known as HIPAA "Guaranteed Issue" Portability)

Click here for a summary description of both of these types of HIPAA Portability. These HIPAA Portability options are included in Options 1 & 4 below

Following are some options, listed in decreasing order - the option that would probably provide the most protection at a reasonable cost is listed first. If that option does not work for you, consider the next option.

First, you should consider enrolling in an Employer Group plan, if possible. This is because:

There is no underwriting required if you are added to a Group plan that is already in-force
Group plans usually have good benefits, at a competitive price
Some Group plans have no pre-existing conditions waiting periods, but many plans have a 12 month waiting period (18 months if you are a late-enrollee)
- Furthermore, HIPAA (Certificate of Creditable Coverage) Portability is a part of the Federal law that allows you to reduce or eliminate your waiting period for Pre-Existing Conditions, by giving you credit for prior coverage. This is available for those enrolling into GROUP coverage, if you have had prior health insurance, without a lapse of 63 days or more. (The waiting period for new-hires to become eligible for their Employer's plan is not included in the 63 days)
- Pregnancy is not considered a Pre-Existing Condition for GROUP plans

Enrollment in a Group plan may be under various circumstances, such as:

A New-Hire
Mid-term enrollment - in your Employer's plan or your Spouse's Employers plan. You may enroll if you have a "qualifying event", or at "open enrollment", or as a late-enrollee.
A NEW group plan, as explained below

Perhaps you are not able to enroll in an existing Group plan (through your Employer, or your Spouse's Employer). However, you may wish to establish a NEW group plan. The reasons you should consider a new group plan include:

Businesses with 2 or more Employees cannot be denied health insurance coverage (however, the premium may be rated up)
Businesses with several Employees can enjoy better rates, if there are several healthy Employees to offset the one with the medical condition
The Insurance Company can only underwrite once - when the initial Group plan is instituted. From that point on, newly hired employees can enroll in the Group plan without underwriting.
Businesses with 1 Employee (including sole-proprietors, 1099 independent contractors, or distributors of products such as Avon & Tupperware) can access a health plan in Arizona that is moderately priced, and will NOT require medical underwriting.

Click here to get a quote for Group health insurance for your Business

Second, you should consider exercising any COBRA rights. COBRA is a Federal law that requires businesses with 20 or more full-time employees to offer you a continuation of your Group health insurance benefits. The premium can be raised only 2% (for administrative costs). However, you will pay the whole premium (including the portion your Employer previously contributed toward the premium). There are specific timeframes & deadlines you must meet in order to elect COBRA. Usually, you can keep your COBRA continuation of coverage for 18 months, but in some cases it can last up to 36 months. After your COBRA has ended, you may wish to become insured under a HIPAA (Guarantee Issue) Portability plan, discussed below.

Third, you should research any options you have to Retirement coverage or Conversion. If your Employer offers health benefits for Retirees, this plan may be very beneficial. However, we rarely recommend Conversion plans, because they are notoriously limited in benefits and high in premium. You should ask about any Retirement or Conversion rights, and analyze these options. Please be aware that enrollment in a Retirement or Conversion plan may disqualify you for COBRA, and will definitely disqualify you for option 4 below - HIPAA (Guaranteed Issue) Portability rights.

Fourth, you should consider exercising your HIPAA (Guaranteed Issue) Portability rights. The Federal HIPAA laws allow you a guaranteed right to purchase an Individual / Family plan. These plans are identical to the ones marketed to the general public except for three points - there is no waiting period for pre-existing conditions, you may not be turned down due to medical conditions, and the premium is far more expensive. Eligibility rules include the following:

you must have been insured for at least 18 months, without a lapse in coverage of 63 days or more (the waiting period for new-hires to become eligible for their Employer's plan is not included in the 63 days)
your most recent coverage must be GROUP coverage (COBRA is also considered Group) Caution - enrollment in a Short-Term plan, or any other Individual plan will disqualify you.
you must have exhausted all COBRA rights that were available to you
you must not be eligible for other Group health insurance, Medicaid, Medicare or AHCCCS
you may not be covered under any other health insurance

For more information about all the eligibility rules, and about the benefits & premiums, contact the Insurance Company of your choice & ask about their HIPAA (Guaranteed Issue) Portability plans.

Fifth, you should consider applying for an Individual / Family plan. Some Insurance Companies will approve coverage for an individual with medical conditions, through a "modified" offer.

Modified offers include premium rate-ups, exclusion riders, or a combination of both. For example, the Underwriter may approve the application, but require more premium (called a rate-up). An exclusion rider (sometimes called a waiver) is an agreement attached to the policy, and accepted by the insured. It states that the Insurance Company will accept you as an Insured, but they will EXCLUDE coverage for a particular medical condition. Depending on how the rider is worded, this may be acceptable to you.

If the modified offer is not acceptable to you, you DO NOT have to accept it. Furthermore, if you refuse the insurance, it does not disqualify you from the options above (Group, COBRA, or HIPAA (Guaranteed Issue) Portability).

If you accept the coverage, however, it will definitely disqualify you for HIPAA (Guaranteed Issue) Portability, and may disqualify you from COBRA. Be sure to check the Pre-Existing Conditions Waiting Period clause, and make your decision wisely.

Click here to get a quote for Individual / Family Plans

Sixth, you should consider taking a Short-Term (Temporary) Health Plan, if the options above do not work for you.

The reasons you should consider a Short-Term plan are:

Coverage can begin as soon as the day AFTER the application is submitted
The premium is VERY reasonable, and the benefits are good
You can be covered, up to 12 months
There are very few health questions on the application. Different Insurance Companies ask different health questions, and you may find a Short-Term plan that will accept your application.

Negative issues to consider are:

The plan will NOT cover a pre-existing condition (but it will insure you for accidents and other medical conditions that may arise during the term of insurance)
After 12 months, the insurance is over - no renewal options
This is Individual coverage, not GROUP, therefore it will disqualify you from HIPAA (Guaranteed Issue) Portability discussed in option 4 above

Click here to see the Short-Term plans, premium rates & applications

Seventh, you should consider Governmental Programs and Social services, including Medicare, Medicaid, AHCCCS, etc. For children, you should consider KidsCare, Children's Rehabilitative Services, and other programs meant to provide healthcare to children. For pregnant women, look on County & State websites for programs meant for Women, Infants & Children. Your OB/GYN will know more about these programs. If you are disabled, you should consider applying for Medicare through the Social Security System.

Oftentimes, the County or State will provide preventive care services (such as immunizations, mammograms, etc.) to those who do not have health coverage. Visit the website for the Arizona Department of Health Services (ADHS), and the website for the Maricopa County Department of Public Health. There are various programs for the poor, as well as for pregnant women & children.

If you have a specific disease, such as Cancer or Diabetes, contact your foundations & associations for guidance about access to affordable healthcare services. Special programs are often provided by clinics & hospitals to provide affordable care to those who cannot access true healthcare coverage.

Eighth, you should consider enrolling in Medical Discount programs, and Limited Benefit programs. We absolutely DO NOT recommend these unless you have exhausted the options above. Do not cancel any current coverage, or bypass any rights to coverage, in order to enroll in one of these programs. These are not true health insurance programs. Following is a brief description of some of the programs and plans available:

Medical Discount Programs. These programs allow you to access a network of Providers, and receive the same kind of discounts given to large Insurance Companies. These discounts can be significant. However, this is not health insurance, but a Discount program only. Some examples of Medical Discount Programs include:

Care Entree
Prescription Discount Cards - ask your Pharmacist, including the Pharmacy at membership-type stores such as Costco
You may wish to contact your Doctor or Hospital to learn about programs they may have, which will give you access to care, at the discounted rates enjoyed by those who are covered under most Health Insurance plans. Hospitals sometimes discount fees, based on financial hardship, and healthcare necessity. Often, they have special programs for children and for pregnant women.
You may have membership in clubs or associations that offer discounts for medical/dental/vision services. Check with your credit card companies, club memberships, associations, and health-related foundations.
Many times a variety of Medical Discount Programs are attached to "Limited Benefit Plans" described below

Limited Benefit Plans. These plans are known as Hospital Indemnity plans, Surgical Benefit Plans, etc. Beware that these ARE NOT true health insurance. Although the brochure may tout the fact that they are "insurance programs", they are by no means comprehensive health insurance. They have very limited benefits.

Many of these programs offer a mixture of "insurance" programs, along with Medical Discount programs. Sometimes they advertise that there is "no medical underwriting required", and "no waiting period for pre-existing conditions". However, usually the Medical Discount portion of the program is available without medical underwriting or waiting periods for pre-existing conditions. But, often, the "insurance" portion of the program requires medical underwriting (health questions on the application), and has a waiting period or exclusion for pre-existing conditions. Also, the "insurance" portion of the program is very limited in benefits, and cannot be considered comprehensive health insurance.

Mini-Med
US Now
BGA's plan
Chittenden's plan

I cannot cannot afford the premium, because my premium was rated-up due to medical conditions, or I am in a low-income category

If your premium was rated-up, due to medical conditions, read the section above which gives options for those with medical conditions.

For others, consider the following hints for lowering your premium:

Try switching to a PPO, instead of an HMO (especially cost saving for women & children)
Try lowering your benefits, such as:

A larger deductible
Higher copays
An 80% plan, instead of 90%, especially if the “Out-of-Pocket” is the same
A “catastrophic” plan
An HSA (Health Savings Account), where you take a high deductible, then put the premium savings into a cash fund that is tax deductible
- Click here to get quotes for your family, and to see plan comparisons

For Individual / Family plans only - Try switching Insurance Companies, even if you have to split family members into different plans to maximize the savings. You will find a premium breakdown by family member on all the plans we quote. Click here to get quotes for your family, and to see plan comparisons
Short-Term (Temporary) Health Plans are very inexpensive, however they are not intended to be a choice for your long-term health insurance needs. Click here for brochures, rates & applications for Short-Term Health Plans.
For Group plans only - consider alternative funding, like Consumer-Driven Health Plans (CDHP's), Partially Self-Funding, etc. Click here for more information
For Group plans only - consider tax-favored plans, like Health Reimbursement Accounts (HRA's), Flexible Spending Accounts, Section 125 Premium Only Plans (Tax-Free Premium Plans), etc. Click here for more information

If you are in a low-income category, and cannot afford health insurance at all, there are various agencies that could help. Following are links to some of the most popular choices:

KidsCare
AHCCCS (for the State of Arizona) - they have various programs, and referrals to other services
Maricopa County Department of Public Health

I just lost my health insurance (most likely due to a change in jobs)

If you had a change in jobs (with a loss of your health insurance), you may consider the following options. If you also have a medical condition, and may have trouble qualifying for an Individual / Family plan, please read the first section above. Following are the options most commonly available to those who have recently changed jobs:

Employer Group Plan - You will probably have a "new-hire waiting period", before you become eligible for the Group plan through your new Employer. You should consider a Short-Term plan (or another option below) to fill the gap, during your "new-hire waiting period". If the cost is high for your new Employer's Group plan (or if your new Employer does not offer health insurance), consider one of the following options.
Short-Term Temporary Plan - A “Short-Term” Temporary plan fills the gap between plans, (for instance, while you are waiting for your new Employer's Group plan, or while you are in the application process for an Individual/Family plan). Click here for more information about Short-Term plans, including some cautions for those individuals with pre-existing conditions, and rights to COBRA or Guaranteed Issue.
Individual/Family Plan - Even if your new job provides Group health insurance, you should consider an Individual/Family plan. This may be the least expensive choice. However, it is medically underwritten (i.e. you will be asked health questions), and the application process will take some time. Click here for a quote and plan comparisons.
COBRA - You may be offered COBRA continuation of coverage through your prior Employer. It may be more expensive than an Individual / Family plan, but it comes with more rights. Deadlines apply, so be sure to read your COBRA letter carefully.
Spouse's Employer's Group plan - Loss of your coverage may be considered a "qualifying event", which allows you to join your Spouse's Employer's Group plan, even if it is not open enrollment.
Retirement or Conversion Plans - Retirement plans from your Employer can be great, but we rarely recommend Conversion plans, unless there is no other valid option.
HIPAA Portability (Guaranteed Issue) Plans - These plans are especially important for those who have health conditions, which would disqualify them from obtaining another plan. They are expensive, but they are "Guaranteed Issue", which means you cannot be denied coverage, provided that you meet the qualifications. More information is provided in the section above, concerning those with medical conditions.

Caution: Do not discontinue any coverage, or bypass any rights to coverage options. If you have a medical condition, it is especially important that you learn about your rights to COBRA, or HIPAA (Guaranteed Issue) Portability plans.

Get an Individual/Family Quote

Get a Business Quote

This guide is not intended to be a full description of the benefits, limitations or requirements of each type of plan, nor is it intended to be legal advice. Carefully read the brochures, policies, and certificates of coverage about any insurance plan for which you are interested, specifically the limitations & pre-existing conditions waiting period. Be sure to carefully read your COBRA letter, so that you can comply with deadlines & requirements. Please be sure to learn about your rights to HIPAA portability, including the portability that applies to those who are enrolling in GROUP plans (Certificate of Creditable Coverage) portability, and those who are enrolling in Individual / Family plans (Guaranteed Issue) portability.