The New Health Care Law and Pre-Existing Conditions

Q. I’m over 50 and have been turned away by health insurers who either won’t sell me coverage or charge so much I can’t afford to buy it, all because of my health problems. How long do I have to wait before I can get covered?

A. If you have preexisting medical conditions and have been unable to get health insurance for at least six months, you should be eligible to buy coverage through a temporary federally funded program called a “high-risk pool.” Under the new law, this option—which became available in July—will cover about 2 million men and women in your situation. Older members cannot be charged more than four times what younger members pay for this coverage, and out-of-pocket expenses are limited to $5,950 for an individual or $11,900 for a family this year.

Among the states participating in the program and sharing $5 billion in federal aid are California, Michigan, Montana, New York, Pennsylvania, Washington, and Wisconsin. New York officials have said the state will be eligible for as much as $297 million in federal aid, while expects a potential $761 million. States opting out include Georgia, Indiana, Minnesota, Nebraska, Nevada, and South Carolina. The federal government will operate the program in those states that don’t participate.

How much premiums will cost to join the high-risk pool, available subsidies, which hospitals and doctors will participate, and exactly what will be covered are among the key details yet to be worked out. For the latest information – including whether your state is in or out – contact your state department of insurance (for the telephone number, call the National Association of Insurance Commissioners’ consumer hotline at 1-866-470-6242).

This program ends in 2014, when insurance companies will be required to sell policies to anyone, regardless of their preexisting medical conditions.

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.