Getting Health Insurance with A Serious Expensive Pre-existing Condition As A Resdent

[JohnHenry]

and later as a Doctor. I am listed as a dependent on my fathers plan which can't last much longer. I believe I will be dropped like a hot rock as soon as the insurance company can get away with it. Anybody have any info on how I can maintain my health insurance as a resident and later a doctor assuming my insurance lasts until I graduate from med school? Thanks for any info you might have.

---

Members don't see this ad.

 

[LaCirujana]

and later as a Doctor. I am listed as a dependent on my fathers plan which can't last much longer. I believe I will be dropped like a hot rock as soon as the insurance company can get away with it. Anybody have any info on how I can maintain my health insurance as a resident and later a doctor assuming my insurance lasts until I graduate from med school? Thanks for any info you might have.

Most residency programs and future employment situations you will likely encounter offer group insurance plans. As I understand it (anyone w/more experience, feel free to correct me), if a group plan covers one member, they must cover any member, pre-existing conditions or not. I, too, have a fairly expensive pre-existing medical condition and my coverage under my parents' plan ran out while I was in med school. I was unable to get individual coverage due to this condition (ended up w/a COBRA plan that cost a bundle, but less than my medications), but had no problem once I started residency and was covered by one of the group plans offered by my hospital.

 

[k's mom]

Yup, that is exactly how it works...just don't plan on going into "solo" or "small group" practice and you will be fine. Under an employer-sponsored plan, or as a spouse under your spouse's employer-sponsored plan, you will pay the same premium and have the same waiting period as everyone else. My mother is a type-I diabetic and even though she has worked full-time since she was 15 and has saved extrememly well, she does not have the option of retiring early.....she just has to save ALOT more, keep working, and hope Medicare is still around ten years from now (and hope she outlives most Type I life expectancies so that she can have some years to ENJOY retirement!).

Remember: As a resident, you are ("Usually") considered an employee of the hospital...check the websites of the programs you are applying to and look at the house staff benefits.

 

[DrMom]

Most residency programs and future employment situations you will likely encounter offer group insurance plans. As I understand it (anyone w/more experience, feel free to correct me), if a group plan covers one member, they must cover any member, pre-existing conditions or not. I, too, have a fairly expensive pre-existing medical condition and my coverage under my parents' plan ran out while I was in med school. I was unable to get individual coverage due to this condition (ended up w/a COBRA plan that cost a bundle, but less than my medications), but had no problem once I started residency and was covered by one of the group plans offered by my hospital.

The group plan has to take you, but if you haven't been on a group plan (note: either without ins at all or on an individual plan) continuously before that they can put waivers on your pre-existing condition.

 

[k's mom]

Good point, Dr. Mom! I didn't consider that the plan he may be under with his parents might be an individual plan. This is the reason for all of the pesky pieces of paper you will start recieving when you start jumping from plan to plan...my family and I had EIGHT plans in three years...the paperwork sucks!

 

[Snoopy]

This is a great question and something that I have often worried about myself. Thanks to HIPAA I don't worry about it anymore. That's right, the same legislation that drives us a little nuts at times in the clinical world provides us with some very important rights. The act was actually designed to reform insurance, hence the name "Health Insurance Portability and Accountability Act". A link to the Centers for Medicare & Medicaid Service below provides a lot of details that are too lengthy to get into here. I think EVERYONE should read this information so that as you enter the world of employment you know your rights in the benefits realm.

As it relates to your question, however, HIPAA basically states that if you have been continuously insured, no insurance company may deny you coverage under a pre-existing condition policy when you switch plans (group plans--any insurance company may still refuse to give you an individual policy). There are a few exceptions but essentially it's that simple. So the key here is to always remain covered--don't ever let your coverage lapse, not even for one day (it doesn't ruin your rights under HIPAA, just diminishes them). That said, if you lose coverage under your parents plan because of age, you may retain coverage under their plan for up to 18 months under COBRA. You will have to pay the monthly premiums but this is far better than leaving yourself without health insurance or creating gaps in your health insurance history.

Hope that wasn't too confusing. Here's the link:

http://www.cms.hhs.gov/hipaa/hipaa1/content/cons.asp

 

[Snoopy]

The group plan has to take you, but if you haven't been on a group plan (note: either without ins at all or on an individual plan) continuously before that they can put waivers on your pre-existing condition.

HIPAA specifically states: "In general, if you had other health coverage - for example, under another group health plan or under an individual health insurance policy, Medicare, Medicaid, an HMO, or a State high-risk pool - your new plan's pre-existing condition exclusion period must be reduced by the period of your other coverage."

Any kind of coverage counts toward your insurance history.

 

[DrMom]

So it helps, but you could still end up with some kind of exclusion period. I've just run into tons of people who voluntarily leave a group plan for an individual plan without realizing this.

 

[16846]

*Groan*

I am going through this right now as well. I can't afford to keep my insurance, but I can't afford to pay for my medication either. I am stuck between a rock and a hard place.

 

[quixote1974]

I'm in the same boat. I'd like to go into solo or a small group practice, but I'm worried about my insurance as I've been denied an individual plan in the past based on a pre-existing condition. The HIPAA provisions provide some protections but if you have a chronic condition, their six month window they apply to a health condition that can be used as an exclusionary policy I'm gathering won't help me. If I'd like to someday get individual health insurance or from a small group plan, what's my best bet? Make sure that there's no gap in coverage--and how exactly would I do this?