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Health Reform 101

with Lisa Zamosky

WebMD helps readers understand their health insurance and the new health care reform law. The Affordable Care Act is bringing sweeping changes to American health care. Lisa Zamosky is here to help you navigate the health care maze and understand how these changes affect you.

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Tuesday, December 11, 2012

Finding Insurance with a History of Cancer

By Lisa Zamosky

Woman Looking Concerned

Fran, a reader of this blog, recently posted the following question:

I need an individual health insurance policy. I have no health issues now, but I was diagnosed with breast cancer almost 7 years ago. My doctor now says I am free from cancer. Is this considered a pre-existing disease? What are my chances for getting health insurance in the state of Georgia?

Challenging, But Not Impossible

Yes, cancer is considered a pre-existing medical condition, and a serious one at that. On the list of previous medical diagnoses most likely to result in a denied application for health insurance, cancer sits at the top.

However, that doesn’t mean you should shy away from applying.

You mention that you were diagnosed with breast cancer almost seven years ago. Your chance of getting coverage depends on how long you’ve been symptom free. Because cancer treatment can go on for a lengthy period, you need to consider not your date of diagnosis, but the date you were completely out of the woods with regard to your illness – meaning no symptoms, no treatment, nothing at all related to cancer.

It’s common for insurers to look into your medical history as far back as a decade when considering your application for coverage. With no other health issues, being cancer-free for 10 years would leave you with a very good shot at gaining health benefits, although you’ll pay a higher price than if you had never had a bout of cancer.

While success in your case is less certain, if you have been cancer free for the past five years, it’s worth your while to apply for coverage.

Particularly because of your medical history, I recommend you work with a licensed insurance agent who understands your local market. You can find one in any state at the National Association of Health Underwriters website.

Other Possible Routes to Coverage

There are also other options for you to consider.

If you happen to be in business for yourself and work with at least one other employee, you can qualify for a small group plan. The upside to this approach is that, unlike with individual coverage, you can’t be turned down, regardless of each employee’s medical history. These plans are what’s called “guaranteed issue.”

Although there are limits to how much your rates can be increased due to each group member’s medical history, (check with your state’s insurance department to learn about rate hike limits, or ask your broker), insurers are allowed to take this information into account when pricing your plan. With a history of cancer, you should expect to pay more for small group coverage.

And, if you’ve been without health insurance for at least six months, you may qualify for your state’s Pre-Existing Condition Insurance Plan (PCIP). These plans were set up as a part of the Affordable Care Act to extend coverage for the medically uninsurable. The plans are intended to function as a bridge until 2014, when insurers can no longer deny coverage even to those who are sick.

For more information about PCIP plans, including how to apply and premium rates in your state, check out the PCIP page on Healthcare.gov.

Then share your health insurance questions in the comments section below.

Photo: Photodisc

Posted by: Lisa Zamosky at 1:00 am

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