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Updated Options For California Uninsurable and Health Insurance

Things have changed quite a bit since 9/23/2010 in terms of options available for people who are unable to qualify based on health so it’s probably time for a refresher what what’s available on the California health insurance market. The landscape is always changing with 2014 being the dramatic market shift but let’s address what’s available until then.

So let’s start with situation where you are unable to qualify for individual/family insurance doe to pre-existing health issues. We’ll walk you through the options the we usually would on the phone with a client or visitor to the site. People who need coverage usually fall into three categories. They are either losing group coverage or exhausting Cobra (which is continuation of group health insurance); moving to the State from another State and need to purchase California health coverage; and/or they have been uninsured for some time. The scenario you fall in can affect which way to go.

Let’s first look at the Cobra/Group group of people. First, let’s say that you should never lose your Cobra or Group option until you have confirmation of approval with another adequate plan. Do not assume you can qualify and cancel or lose Cobra. You typically have 62 days to elect Cobra from your last date of group health insurance. After that 62 days, the Cobra option disappears. At the end of Cobra, you may have another 18 months called a Cal-Cobra extension. Check with your HR department or carrier to see if there’s a Cal-Cobra extension. This would usually take you 36 months out in terms of total Cobra. Keep in mind that Cobra only exists if the group plan exists. If the company shuts down or closes the group plan (not replace but shuts down), then Cobra also goes away. Cobra is usually expensive so most people try to avoid it but you don’t want to lose the option. Either secure other health insurance first or at least get back the declination before the 62 day window. If you’re exhausting Cobra or in certain cases, losing Cobra involuntarily (as in company closing example above), you may have a HIPAA option with also has the 62 day window (from last date of Cobra or group coverage if shutting down). There are some other requirements but our main message is not to lose these options.

What if you had coverage and are moving to the State but are unable to qualify for California health insurance? That’s a little trickier. Check to see if your prior health carrier as any kind of transfer option or plan. Some Anthem carriers in other states have these set-ups. Health insurance is still State by State which can make things difficult when you move across borders. There is still MRMIP through the State if you have had coverage in the last 6 months. MRMIP typically has a waiting period so check out the site to see where that stands. It’s not cheap but it can be guaranteed issue if you qualify. Qualification is not based on income. On the same website as MRMIP is AIM which is coverage specific to uninsured pregnant women and their newborn baby. It is based on income but between AIM and MRMIP, you have some options to look at.

The reason we mentioned being insured within last 6 months is the kid on the block, PCIP. This is the new Federal program for the uninsured with pre-existing conditions. The main catch is that you have to have been uninsured for past 6 months. The premiums are relatively reasonable so if you are uninsured for past 6 months, this would be our first option.

Group coverage in California is guaranteed issue so if an employer offers coverage, make sure to take advantage of this option at least until you can secure other coverage. Of course, everyone’s scenario is different. We would be happy to help go through your particular circumstance to help you navigate the various California health insurance options available

Dennis Jarvis is a licensed California broker with extensive knowledge of the Individual and Small Group California health insurance market

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