If your health insurance is, or was until recently, provided by an employer or union, you should read up on your legal protections. Key among your rights to continued coverage are two separate but coordinating federal laws known as COBRA and HIPAA, and they are particularly important for anyone with a pre-existing health condition. Understanding both your rights and responsibilities under these laws can help you and/or your dependents maintain eligibility for group coverage. Note that the federal COBRA law applies to employer group plans with more than 20 employees only, but your state department of insurance can tell you about your state’s ”mini-COBRA” law for those in plans with fewer than 20 employees.
Individuals not eligible for group coverage can try to purchase health insurance on their own, for themselves and/or their family members. But it is important to have realistic expectations about the individual insurance market. Knowing something about eligibility rules can spare you the time and frustration of applying for coverage only to be turned down without explanation. For example, only a few states currently guarantee health coverage for individuals regardless of health status: Maine, Massachusetts, New Jersey, New York and Vermont. People living everywhere else are likely to be denied. Applicants with even minor conditions such as allergies can be denied, or at best approved for very limited or expensive policies. You also should be aware that individual health insurance may be even more expensive than group or COBRA coverage.
Other possibilities may exist depending on where you live, your age, disability status or other factors. Fortunately, several online resources now exist that make researching your options easier. To learn more about the programs and protections in your state, check one or more of the following state guides:
- The National Council of State Legislatures - State Health Programs to Cover the Uninsured - This site features state health programs and examples of health reform measures in many states to expand coverage to the uninsured.
- Georgetown University Health Policy Institute - Consumer Guides to Getting and Keeping Health Insurance - Offers information for each state, as well as guidance on managing medical debt and more.
- Robert Wood Johnson Foundation - Cover the Uninsured - Click on your state for in-depth information about insurance programs and information to help those without health coverage, in English and Spanish.
It may take some time for you to determine your best course of action, and you should feel free to ask an MS Navigator™ for help at 1-800- 344-4867. And bear in mind that going without health coverage for more than 63 days will result in the loss of some legal protections, which is why we urge everyone to stay insured if at all possible.
- Medicaid and other public health insurance options
- Prescription drug help
- Finding low or no-cost care
- Managing your personal finances, with or without health insurance