Multiple Sclerosis and HIPPA and COBRA

Mandy Crest Health Guide
  • Whether or not it has yet made its presence known in your family, the health care crisis is all too real for tens of millions of Americans.

    Who are they? They are you and me. They are citizens of the United States of America. They are taxpayers. They are workers. They have pride. They have not spent their lives looking for handouts. They have parents, children and siblings. They have responsibilities. They are the working poor. They are middle class. They are upper middle class.

    They live in a country which boasts the finest health care in the world, but find that availability is limited. Watching the evening news they see stories of the rich and powerful from foreign countries journeying here to take advantage of the very best in medical care. They also see reports of middle class Americans traveling to Mexico, India and other countries on “health care vacations” in order to afford necessary treatments which are out of financial reach here at home.

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    So how did these unfortunate folks end up with no health care coverage? A number of scenarios can lead one down that path.

    • Loss of employment-based health insurance
    • COBRA coverage exhaustion
    • Chronic conditions such as multiple sclerosis can force the patient out of full-time employment or out of the workplace altogether
    • Rapidly rising premiums on individual health insurance coverage can make continued coverage out of reach
    • Inability to find affordable coverage due to health history

    There are some nationwide protections in place.

    HIPPA: If you or your spouse are eligible for group insurance from an employer, HIPPA laws protect you from exclusion from the group health plan due to your health status, nor can you be charged more in premiums. HIPPA will also protect you from being denied individual coverage if you meet all criteria, but does not cap premiums.

    COBRA: If you lose coverage due to separation, divorce, death or children leaving the plan due to age, you may elect coverage under COBRA for up to 36 months, or for up to 18 months due to loss of job. You are 100% responsible for premiums.

    HIPPA is a wonderful protection for access to coverage but does not cap premiums. COBRA will buy you time. Eventually, your time will run out and if you are still not eligible for any group insurance from an employer, you will join the ranks of those applying for individual coverage. If you have a pre-existing condition, however minor, you can expect sticker shock.

    Laws regarding individual coverage vary from state to state. Some states have a high risk pool to assist those who have health issues. Some states have no protection for those who fail to meet the requirements of insurance companies. Still other states require that an insurance company accept all applications -- IF all COBRA has been exhausted and IF no other insurance is available through employment. Some of these states place NO LIMIT on the amount you may be charged for premiums, a virtual rejection for those who can't afford the exorbitant fees.

  • How secure do you feel? Could you find yourself among the uninsured? The answer is yes. Unless you are among the very wealthy, you are just one job loss, one diagnosis, one step away from joining the ranks of the uninsured. Don't wait until this issue arrives at your doorstep. Do your homework now and put health care at the top of your agenda when you enter the voting booth in 2008.
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Published On: December 19, 2007