Health Insurance Options for Individuals with Anemia

Anemia and Health Insurance

Anemia is a disease that can take many different forms, ultimately resulting in a lack of healthy red blood cells. The body is dependent on certain nutrients, vitamins, and minerals in order to produce a necessary amount of red blood cells, namely iron, vitamin B12, and folic acid. A deficiency in any of these can result from a lack of proper nutrition, changes in the lining of the stomach or intestines, slow blood loss, or surgical removal of part of the stomach or intestines. The most common types of the conditions include iron deficiency anemia, vitamin deficiency anemias, anemia of chronic disease, aplastic anemia, sickle cell anemia, and hemolytic anemia.

Depending on the variation and cause of a person’s anemia, whether hereditary and chronic, or attributed to diet, treatment will vary greatly. Iron deficiency anemia is treated most easily, with iron supplements and dietary adjustments. Surgery may be required if the iron deficiency is caused by blood loss, though this type is commonly treatable in a non-invasive manner. Vitamin deficiency is also treated with supplements and vitamins, while more advanced types of anemia may require bone marrow transplants, blood transfusions, or medications. Sickle cell anemics may receive oxygen, pain-relievers, antibiotics, or even a cancer drug called hydoxyurea.

Health insurance coverage is also either available with little changes or automatically declined based on which type of anemia a person has. Based on the state, the insurer, and the applicant, a person with anemia could be declined or accepted for coverage. As with all conditions, it depends on the severity and the potential cost of treatment. For those with a diet-related form of anemia, health insurance is a highly tangible in most cases. Individuals with other illnesses or an inherited form of the disease may be subject to rejection by the majority of the nation’s insurers.

How Anemia Affects Insurability

Persons with anemia as a result of a poor diet, in the iron or vitamin deficiency family, tend to be in the clear for health insurance. Their condition is inexpensive to treat, and if they have shown evidence that they are actively treating their anemia and are aiming towards good health, coverage is not going to be a huge issue. On the opposite end of the spectrum, those who have sickle cell anemia, hemolytic anemia, aplastic anemia, or a form related to chronic illness such as AIDS are usually headed straight for PCIP. This applies only to adult applicants, as children under age 19 cannot be declined for coverage, though premiums may increase. Federal law prohibits anyone age 18 or younger from losing health insurance regardless of their health.

There are a few exceptions, discovered through the various underwriting guidelines on hand at East Coast Health Insurance. Medica seems open to writing health plans for people with various types of anemia, though based on individual consideration. The had the only guidelines that did not state an instant decline of coverage regardless of the person’s current state, or any other factors. This carrier (serving North and South Dakota, Wisconsin, and Minnesota) will at least look into your medical situation a bit further before showing you the door. All other companies are clearly petrified of anyone with a non-diet-based lack of red blood cells.

For those who have an iron deficiency-related case of anemia, most carriers should be able to offer you coverage. As you are able to control your condition somewhat better and with less medical intervention than other types of anemia, insurers are open to bringing you on board. Below are a few examples of health insurance underwriting guidelines from various states and carriers stating their policies on iron deficiency and other forms of anemia. Aetna is the most condition-friendly insurer, especially with this one. They require no additional rates for a case of iron deficiency anemia. While it would be lovely if all insurers followed their lead, for the next year, every insurer gets to decline or rate up whomever they choose, within reason.

Carrier A

Carrier B

Carrier C

USTD = Usually Standard (may result in a rate increase for other health reasons, though typically a standard premium is offered.)

IC – DEC = Individual Consideration to Decline (likely to have rates increase unless your condition is very costly and/or life-threatening, resulting in a full decline.)

Health Insurance Options for Anemia

Those who have a declinable form of anemia will obviously need another source of coverage. As this disease can affect individuals of any age, it is important to know each of your options. For those who are young, coverage is attainable for any income level if you are under age 19. Anyone age 65 or older is must also be covered according to law through Medicare. Adults between 19 and 64 also have several options, though none are legally guaranteed quite yet. Assess the most practical, cost-effective source of insurance, and choose the best fit. Even if you cannot afford or are declined for a private plan, we can help: call 888 803 5917. Here are a few ideas to get your wheels turning on how to get insured sooner.

Employer-Sponsored Coverage

Given the choice of a health plan through your employer, an individual with anemia should take the benefits. Granted, many anemic individuals may be too physically exhausted to do certain types of work, though there are clearly jobs that hire people with this condition. When applying for group coverage, the health plan will not decline anyone with any type of anemia, though everyone on the plan will experience a rate increase as a result. These plans should cover general medical needs and may cover more specific procedures or surgeries. Consult your plan information to find out if a service is covered that you may need prior to making an appointment, in order to avoid confusion.

PCIP

The Pre-Existing Condition Insurance Plan (PCIP) is available to people who have been turned away for a health plan, have no other options, and have been uninsured for at least 6 months. If you meet these criteria with proper documentation, PCIP will cover most types of health care, including the ones that you need the most. A place-holder created by the Affordable Care Act for uninsured Americans categorized as having a pre-existing condition, PCIP is an adequate solution for those in need of coverage.

Medicaid & CHIP

The low-income population of our country can use the government-funded health insurance program, Medicaid, if their income meets their state requirements. In places such as Minnesota, low-income adults with an income up to $2,001 per month can receive coverage through Medicaid, though other areas tend to be much lower. Children, families, pregnant women, and disabled individuals are the greatest beneficiaries from this program, which will cover any medically necessary treatment. Anemic persons with any form of the disease should be able to receive coverage on their treatments, as needed.

CHIP offers coverage for a higher low-income group of children, offering coverage to more Americans under age 19. This program is nearly identical to Medicaid, only there are small fees involved depending on family earnings. These programs will not turn anyone away for their health, only if their income is too high. Medicaid also has a program in every state for people who spend a large portion of their income on medical treatment. The Medically Needy program is also a great option for anemic persons, as Medicaid will help pay your bills.

Health Reform & Anemia

The Affordable Care Act has paved a way for sick people to obtain health insurance coverage, including those with anemia. Anyone who has a pre-existing condition will benefit from this law. At the moment, the nation is still waiting for the full extent of the law to become a reality, and the PCIP is already helping millions of Americans gain coverage. In January 2014, the law will be in place, meaning health insurance companies will not be able to decline anyone for coverage for their illness. Insurers will also be prohibited from issuing exclusion periods and elimination riders. All types of coverage, including those a sick person needs access to, will be covered to some degree.

Additionally, for low-income Americans, the law will allow more people into the Medicaid program. Despite the fact that states now have the option of not expanding their public health insurance programs, those that implement the change will provide many needy people in their local population become insured. Also, for those whose income is above the Medicaid level in their state yet does not allow them to purchase a private health plan, the government will give subsidies to qualifying individuals and help pay their monthly premiums.