A very common condition that affects millions of Americans, allergies can take many forms and be caused by genetics and/or environmental factors. When the immune system’s response is more sensitive than a pre-teen at Hot Topic, allergic reactions occur, and chemicals such as histamines are released. For those experiencing this overreaction to allergens, which would otherwise not affect most people, allergy symptoms form and become very uncomfortable, sometimes painful. Symptoms are always related to the part of the body affected, whether skin, respiratory system, digestive system, or the whole body.
Allergies can be treated in a number of ways, depending on the level of severity. Most treatment involves medication, though avoiding the factors causing your allergic reactions is the best solution, especially for food allergies. Medications for allergies include the common antihistamine or decongestant, as well as corticosteroids, shots, and leukotriene inhibitors. Though medications are typically effective, allergies can lead to anaphylaxis, a life-threatening allergic reaction, complications in breathing while the allergic reaction takes place, or negative side effects of a medication.
As allergies are frequently ongoing, health insurance companies are likely to increase rates or decline an applicant who has a certain type of allergic reaction. Like all conditions, allergies can be the reason a person loses their opportunity to obtain health insurance, though highly based on the seriousness and regularity of treatment. For individuals who receive shots on a monthly basis, the stakes are higher than someone with a seasonal sniffle. However, insurers will be forced to accept people with all types of allergic reactions in a year from now.
Allergies & Applying for Individual Health Insurance
Individual health insurance has long been an exclusive club for the healthy. Underwriting guidelines are an insurer’s rule book for who gets in and who is turned away. With these unfortunate rules in place, sometimes even people with a mildly lingering health problem are cornered into paying double the normal premium. Allergies are given a bit more leeway, though underwriting is specific for each carrier, and usually varies by state. Seasonal allergies should not be an issue for health insurers, nor should be light use of medications, though every carrier has its own policies.
Once you step into allergy injection territory, the likelihood of paying more or being declined is inevitable. Some carriers are kinder than others, therefore we suggest shopping around and doing the research in your area. This can be done quite easily by calling one of our agents for a few minutes of education at 888 803 5917, or the long way, of trial and error. To cut down on guessing games (and lost time and money), we recommend Aetna, if they serve your region. Otherwise, call us and we are happy to find an insurer in your area that may be able to play fair. Even if a company accepts you for coverage, they can increase your rates or issue an exclusion period, where you would be unable to receive coverage on allergy medications or treatment for up to 12 months, 24 in some states.
The underwriting guidelines of a company are often a gray area until more health information and a medical history is gathered and applied to an individual. Therefore, it is impossible to predict whether or not a person with allergies will be turned away from a plan without a thorough assessment. This excerpt from an underwriting guide featured below shows how one company bases their rate increases or declines for allergies. Though there is certainly a window of acceptance for many individuals, even the possibility of paying normal rates, there is also a chance that someone could lose eligibility for undergoing testing.
Again, this is listed for a particular insurer in one of their states of representation, so if you are pondering policies in your area and their leniency towards allergies, contact us for more information. Also, keep in mind that no one under the age of 19 can be declined coverage. Therefore, if your child has allergies, even to a severe degree, they cannot be turned away from any health plan according to federal law.
Alternative Health Plans for Allergies
If you happen to have a serious case of allergies, none of the health plans in your area are willing to give you a decent price, or any coverage whatsoever, your hives will soon be taken care of by another plan. There are several other ways to get a health plan other than the individual market. For those who thought they had no other choice but an individual or family plan, PCIP is offered in every state until health reform reigns supreme. Those who cannot afford coverage to begin with may have the option of a public health plan, depending on their state’s income regulations. Also, don’t forget about employer coverage. If you or your spouse has the chance to use their job’s health benefits, by all means do. Here are a few ideas that may be available to you depending on your life situation, employment, income, and other circumstances.
The Affordable Care Act was considerate enough to create a place for people to get coverage in the meantime while insurers can still decline as they please. Pre-Existing Condition Insurance Plans offer coverage to anyone who has been rejected by a health insurance company, or have medical evidence that they will be (a letter from your physician), and uninsured for at least six months. By offering a comprehensive health plan to those who need health care most, PCIP is a sufficient place holder for those with no other choice.
This program has insured millions of Americans over the past 2+ years, and though it may not be as diverse as an individual PPO, it gets the job done. PCIP will cover the medications and shots a person needs to control their allergies, and will not issue any exclusion periods. All covered benefits will be available as soon as the plan begins, which is a great help to anyone with the need for ongoing allergy treatment.
Those who have the option of coverage through their employer should use the benefits they are provided. Though it is not guaranteed that every service you need will be covered, at least the key ingredients for staying healthy will be included. Every employer chooses a different plan, and many times this decides their employees plan type in advance, while others give their workers a few options. As your employer pays for a portion of the premiums, coverage will be within a decent price range.
Although the health plan cannot decline anyone for coverage, they are able to make you wait several months while they approve your application. In this case, you may want to make sure your current benefits do not run out before the new plan starts, or get a short term plan if it does. Group coverage will certainly accommodate a person with allergies, as it is not the most severe illness of all time. Usually rates increase when a person with a condition joins the plan, though allergies should not impact the cost too dramatically.
Medicaid & CHIP
If you are unable to afford a private health plan because of your income, yet need assistance paying for allergy medications, treatments, and general health care, Medicaid is the usual go-to. Each state has its own specifications for income as well as coverage, though once you are accepted and enrolled, getting your allergy medications covered will not be an issue. Medicaid usually accepts children, families, pregnant women, and recipients of SSI, though a few states have opened it up to adults without children or disabilities. Check your state’s income guidelines to see if you qualify by contacting your local Department of Health and Human Services.
CHIP is a great program if your family income is over the Medicaid limit, and you still cannot afford a private health plan. Children under age 19 will be approved for CHIP no matter what their health or income, though subsidized coverage cuts off at 300 percent FPL. Like Medicaid, the Children’s Health Insurance Program will cover any specific health needs a member has. Medicaid also has a program (Medically Needy or Spend Down) for individuals who spend a large sum of their income on health care bills, which will help you pay for them.
Health Reform & Allergies
People with allergies should be in favor of what the Affordable Care Act will do for them in the future and has already done by making PCIP. By eliminating discrimination in the insurance industry, the ACA has made a pathway to health insurance for anyone with a pre-existing condition. As of January 2014, the law will prohibit any insurer from declining anyone with allergies, nor will they be able to issue exclusion periods or elimination riders. They can also not increase your rates by more than 10 percent over the normal premium, for any condition. This will greatly affect anyone with allergies or any other condition, as they will be able to purchase a plan without feeling the process is unjust.
Addressing lower income Americans, Medicaid expansion (though optional) will include a larger number of people, including a new group. State officials who decide to have any concern for their needy residents will open Medicaid to adults without children or a disability, whose income is at or below 138 percent of the Federal Poverty Level. Those who have an income over the Medicaid limits and below that of affording the most bare bones plan from a health exchange, the government will issue subsidies. These checks should help cover the cost of monthly premiums for “bronze plans” on their state’s health exchange, the government’s answer to individual coverage. Though the healthcare law has been threatening several industries, it should be helping the public greatly by offering coverage and assistance for those who have conditions.
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1. U.S. National Library of Medicine. “Allergies”. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001815/.