Losing Your Health Insurance

My insurance was terminated—now what?

What did the notification say? 

Are they refusing to continue your insurance because you’ve changed jobs? Are they refusing because you have not been employed long enough? Are you really uninsured? Did you forget to make a premium payment? Knowing the cause of the termination is an important step toward action.

What is the reason for termination? 

If it is not clear, call the insurance company or your employer and find out. Once you figure out why your insurance has been terminated, you need to decide whether or not you want to fight it. Do you have a legitimate reason to fight it?

Can you appeal the decision? 

A clue might be in the letter you received from the insurance company, in your policy, or in your employee handbook. If there is an appeal process, be sure to read it carefully so that you know what you need to do. You may want to mark your calendar if you need to get a letter of appeal to the company by a certain date. You will want to write the best appeal letter possible. Get someone to help you put together the format and the important points that will best present your case.

If the Insurance Is a Type of Public Insurance (Like Medicaid), You Have Important Appeal Rights

Unless you've just won the lottery, you do have appeal rights under Medicaid. Check with your Department of Social Services. Your Medicare coverage should not be terminated unless you stopped paying your premiums. If you did stop because you were unable to pay, check with your Social Security office for possible help.

Do you think they have discriminated against you? 

If so, you need to see if it is illegal discrimination. Employers find ways to discontinue benefits in legal ways all the time. Not all discrimination is illegal, but if you believe you were discontinued because of your race, national origin, gender, handicap, marital status, or something else beyond your control, check with your State Health Insurance Assistance Program (SHIP), a lawyer, or a patient advocacy group for help. (See our webography.)

How can HIPAA help me now?

The Healthcare Insurance Portability and Accountability Act (HIPAA) is a federal law enacted in response to an increasingly common and frightening problem for workers called “job lock.” Before HIPAA, many people would not or could not change jobs because new health plans may have had pre-existing condition clauses. This meant that if you changed jobs while you were being treated for something like cancer, your new insurer could refuse to cover that condition. Insurers almost always refused coverage to cancer patients before HIPAA.

Now your new health plan cannot deny you coverage based on your health status when you are moving from one group health plan to another (with little or no gap in coverage), if your previous plan is considered creditable coverage. Since HIPAA is a federal law, it applies to group health plans in all 50 states. The interpretation of the law varies from state to state. Check with your State Health Insurance Assistance Program (SHIP) to get a local interpretation before moving out of your job.

• Who is covered? In general, HIPAA applies only to group plans sponsored by an employer, union, government agency, or church. However, some states allow group plans to extend the coverage to include “groups of one.” You also need to meet special criteria if you are going to be self-employed.
• Time is of the essence. Begin researching your options ahead of time, if possible. Before you leave your employer, ask for a certificate of “creditable coverage.” And, once you’ve left, do not let your health insurance lapse for more than 63 days (the magic HIPAA number), or you could lose your HIPAA rights. This can then mean no insurance coverage for a period of time.
• No job or policy in mind? You’ll want to seriously consider accepting COBRA, Temporary Continuation of Coverage (TCC), high-risk insurance, Medicaid, or state continuation coverage. You must save your continuity of coverage so that HIPAA can protect you from those pre-existing condition clauses once you obtain your next long-term health plan coverage.

My employer discontinued my insurance. Is this right?

Employers are allowed to discontinue coverage, increase premiums, or reduce benefits. They must do it fairly, and they must provide you with information about your options. Your employer is obligated to provide you with information and an application for COBRA, which can cover you for up to 18 months.

• Make sure that your employer is acting fairly and legally. Your employer must offer or decline to offer insurance to everyone within certain job categories in a manner that is fair and equal for each person. This means that if insurance is no longer offered to employees, but is still offered to managers, then everyone who is not management should be excluded and everyone who is management should continue to receive the same benefit. Employers may not discriminate on the basis of disability—for example, taking only people with serious and expensive conditions (such as cancer) off the company’s health insurance. Contact your state office of employment or your union if you feel that you are being treated unfairly.
• Consider looking for a new job. If health insurance is almost always offered to folks in your occupation, you may be able to find a job with health care benefits from another employer. Thanks to HIPAA, the new health plan cannot deny you coverage based on your health status if you move from one group plan to another with little or no gap in coverage (see HIPAA information above for more information). But if you go without insurance (which is called creditable coverage) for an extended period (more than 63 days) before getting into a new group plan, you or your family’s pre-existing conditions may be excluded from coverage for several months. Act right away!
• Investigate your COBRA. You can extend your previous coverage by paying the premiums to the insurance company yourself or through an intermediary under this federally mandated program. Depending on your circumstances, COBRA coverage may continue for up to 18 months. Be careful to follow the rules, though. COBRA can be complicated, and sometimes the premiums are lower if you get private insurance yourself (although the coverage may also be less). The good news about COBRA is that it might prevent you from having a gap in cancer coverage—it will bridge insurance coverage and might prevent a benefit waiting period in your next job.
• Consider purchasing private insurance. Private insurance is insurance you buy for yourself and/or other members of your family. It may be obtained through either an insurance agent who works for one particular insurance company or a broker who represents a variety of companies. You may purchase it online as well. The important thing with private insurance is to shop around and get the best deal. However, these insurance companies may not cover your cancer right away. You need to know that before you sign up. Other questions you might want to ask include:

1. How much of my doctor and hospital bills will this health insurance plan pay for?
2. How much will I have to pay each month (premium) for this plan?
3. How much will I have to pay (deductible) before the plan begins to pay?
4. How much will I have to pay for office visits to the doctor?
5. Does this plan pay for preventive health care? This includes routine medical checkups and shots to prevent disease, such as flu shots.
6. Does this plan have rules for people who already have serious, chronic medical problems? Will these rules keep me from getting the care I need? If so, for how long?
7. What services are covered by this health insurance? Will it pay for care at a hospital emergency room or urgent care center? Does it cover routine surgery, hospital stays, doctor visits, nursing home stays, home health care, and medical equipment and supplies?
8. Does this plan cover prescription drugs?
9. Does this plan pay for catastrophic medical costs—costs that are so high it would take most of my money to pay for them? Is there a limit to how much I must pay each year?
10. Is there a yearly or lifetime limit to how much the plan will pay for medical costs?

• Check out your state’s high-risk insurance. If you’ve been turned down for private insurance because you have a cancer or HIPAA does not apply to your case, you may have difficulty purchasing insurance. While the rules vary from state to state, high-risk pools resemble private insurance with an important difference: The premiums can cost more than they would on the open market. Despite the high costs and other obstacles (such as the fact that all states do not have them), many states have waiting lists to get into these pools.

What is high-risk insurance?

Health insurance risk pools are special programs created by state legislatures to provide a safety net for the “medically uninsurable” population. These are people who have been denied health insurance coverage because of a pre-existing health condition, or who have access only to private coverage that is restricted or has extremely high rates.

Each state risk pool program is different. Generally, the programs operate as state-created, nonprofit associations. The board of the pool contracts with an existing insurance company to collect premiums, pay claims, and administer the program on a day-to-day basis. Insurance benefits vary, but risk pools typically offer benefits that are similar to basic private-market plans: 80/20 insurance/coinsurance, major medical and outpatient coverage, and a choice of deductible and co-payments. Maximum lifetime benefits vary by state from as low as $350,000 to as high as $2 million. If the lifetime benefit is less than $500,000, this might not be the best insurance for a cancer patient.

It is important to note that risk pools are not created expressly to serve the indigent or poor. Risk pools are designed to serve people who would not otherwise be able to purchase health insurance protection. Indigent patients have other forms of assistance, such as Medicaid.

What does high-risk insurance cover, and what does it cost?

Generally, there are no exclusions. However, risk pools might have waiting periods for coverage of pre-existing conditions to make sure individuals pay for continual coverage from employers. They may have waiting lists for enrollees. Some of them would go broke if they did not have waiting lists. However, under the HIPAA legislation, people who have had continuous coverage in the group market, not broken by more than 63 days, can buy coverage in risk pools without any waiting periods.

Risk pool insurance may cost a bit more than regular individual insurance. However, the premiums are capped (limited) by law in each state to protect individuals from exorbitant costs. The caps range from as low as 125 percent of the average for comparable private coverage in some states, up to 200 percent of the average or more in other states. Most states offer coverage at less than 150 percent of the average policy cost.

Should I apply for high-risk insurance?

First of all, not all states have it. Here are the ones that do:

Alabama (for portability only)

Alabama Health Insurance Plan, (800) 513-1384 or (334) 353-8924

Alaska 

Alaska Comprehensive Health Insurance Association, (800) 467-8725 or (907) 269-7900

Arkansas 

Arkansas Comprehensive Health Insurance Plan, (501) 378-2979

California 

California Major Risk Medical Insurance Program, (800) 289-6574 or (916) 324-4695

Colorado 

CoverColorado, (303) 863-1960

Connecticut 

Connecticut Health Reinsurance Association, (800) 842-0004

Florida (not open for new enrollees)

Florida Comprehensive Health Insurance Plan, (850) 309-1200

Idaho 

Idaho Individual High-Risk Reinsurance Pool

Individual insurance carriers offer high-risk individuals for standard plans, reinsured by the state high-risk reinsurance pool. For more information, contact the Idaho Department of Insurance, (208) 334-4250.

Illinois 

Illinois Comprehensive Health Insurance Plan, (800) 367-6410 or (217) 782-6333

Indiana 

Indiana Comprehensive Health Insurance Association, (800) 552-7921 or (317) 614-2000

Iowa 

Iowa Comprehensive Health Association, (800) 877-5156

Kansas 

Kansas Health Insurance Association, (800) 290-1366 or (316) 792-1779

Kentucky 

Kentucky Access, (866) 405-6145

Louisiana 

Louisiana Health Plan, (800) 736-0947 or (504) 926-6245

Maryland 

Maryland Health Insurance Plan, (866) 780-7105 or (410) 576-2055

Minnesota 

Minnesota Comprehensive Health Association, (952) 593-9609

Mississippi 

Mississippi Comprehensive Health Insurance Risk Pool, (601) 362-0799

Missouri 

Missouri Health Insurance Pool

For all but northwest Missouri: (800) 843-6447

For northwest Missouri: (800) 645-8346

Montana 

Montana Comprehensive Health Insurance Association, (406) 444-8200

Nebraska 

Nebraska Comprehensive Health Insurance Pool, (402) 343-3337

New Hampshire 

New Hampshire Health Plan, (800) 578-3272 for customer service; (603) 227-7265 for plan executive administrator

New Mexico 

New Mexico Medical Insurance Pool, (505) 271-4399

North Dakota 

Comprehensive Health Association of North Dakota, (800) 737-0016 or (701) 282-1235

Oklahoma 

Oklahoma Health Insurance High-Risk Pool, (800) 255-6065 or (913) 362-0040

Oregon 

Oregon Medical Insurance Pool, (503) 373-1692

South Carolina 

South Carolina Health Insurance Pool, (803) 788-0222

South Dakota 

South Dakota Risk Pool (for eligible high-risk individuals with 12 months of previous creditable coverage), (800) 831-0785

Tennessee 

TennCare Program

Contact Tennessee area county medical assistance offices, or (615) 741-8642

Texas 

Texas Health Insurance Risk Pool, (888) 398-3927 or (512) 441-7665

Utah 

Utah Comprehensive Health Insurance Pool, (866) 880-8494 or (801) 333-5573

Washington 

Washington State Health Insurance Pool, (800) 877-5187 or (360) 407-0380

West Virginia 

AccessWV, (866) 864-6142

Wisconsin 

Wisconsin Health Insurance Risk Sharing Plan, (608) 264-7733

Wyoming 

Wyoming Health Insurance Pool, (307) 634-1393