State coverage and health insurance options for the hard-to-insure

People with health problems are often denied private health insurance or have trouble finding affordable coverage. The Affordable Care Act (ACA), passed in 2010, does not allow insurance companies to deny coverage to children with pre-existing conditions (such as diabetes or cancer) as of September 2010. Starting in 2014, it will not allow adults to be denied coverage for pre-existing conditions. But in the meantime, there are some options available for adults who have had trouble getting health insurance.

For a number of years, some states have sold comprehensive health insurance to state residents with serious medical conditions who can’t find a company to insure them. These state programs, sometimes called risk pools, serve people who have pre-existing health conditions.

Under the Affordable Care Act (ACA), every state must have a Pre-Existing Condition Insurance Plan (PCIP) for people who have not had insurance for 6 months or more and have cancer or another pre-existing condition. Whether the state or the US Department of Health and Human Services runs the PCIP program depends on the state. The program name and design may also vary by state. (Go to www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html for the most current information on what’s available in your state.)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides nationwide standards and a guarantee of access to individual health insurance for some people who are losing their group health insurance coverage (see the section on HIPAA). But this doesn’t mean that you will be able to afford it or that it will cover what you need.

All states are different. Some have special laws requiring that insurers offer health insurance to anyone who applies. This is called guaranteed issue. A few states also limit the premium the insurance company can charge, even if a person has a pre-existing condition. This is called community rating. If you live in a state that requires community rating, you are not as likely to need insurance risk pools or PCIPs.

To find out which public, private, or community health insurance programs best meet your needs, please see the “Find Insurance Options” tool on the US Department of Health & Human Services Web site www.healthcare.gov/using-insurance/understanding/options/. This tool was created to help consumers through the Affordable Care Act. You can also call your American Cancer Society for answers to your insurance questions. Other resources that may be helpful are listed in the “To learn more” section.