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 be prescribed oxygen, pain-relievers, antibiotics or even a cancer drug called hydroxyurea.

Health insurance coverage is available to people will any type of anemia with no condition-based benefit restrictions or premium increases. However, this wasn’t always the case. Until the beginning of 2014, anemia could have an extremely variable outcome when applying for a health plan. Some types were accepted, while others were declined. Depending on the severity of the case and how it was treated, this condition could keep you from getting the right coverage, or any at all. High-risk pools were often the solution for anemics, but since the Patient Protection and Affordable Care Act changed the scope of insurance, you can apply with any company without getting declined or wasting time.

 

Anemia and Insurability: Past and Present

PRESENT

Health Reform and Anemia

Federal law currently prohibits anyone age 18 or younger from losing or being ineligible for health insurance, regardless of their condition or medical history. The Affordable Care Act allows sick people to obtain health insurance coverage through any health plan; private or government-run. Health insurance companies cannot decline anyone a policy or increase rates based on an illness. Insurers will also be prohibited from issuing exclusion periods and elimination riders, preventing people from receiving certain types of coverage they need. A plan still may not cover certain benefits, but an insurer cannot specifically block you from treatments designed for your condition. More types of coverage are also more attainable through the law, including preventive care at no cost.

Additionally, for low-income Americans, the law allows more people into the Medicaid program in certain states. Also, for those whose income is above the Medicaid level in their state, yet is not enough to purchase a private health plan, tax credits are offered to qualifying individuals to help pay their monthly premiums, and subsidies are also issued to reduce medical costs.

 

PAST

If you had anemia as a result of a poor diet, in the iron or vitamin deficiency family, you would usually be in the clear for health insurance. Since this type of anemia is inexpensive to treat, coverage would not have been unattainable, especially if you were living a healthy lifestyle. On the other hand, if you had sickle cell anemia, hemolytic anemia, aplastic anemia, or a form related to a chronic illness such as AIDS would usually be declined and need to seek coverage through a risk pool. Between 2011 and 2013, this applied only to adult applicants, as children under age 19 could not be declined for coverage, though their premiums could increase.

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

For iron deficiency-related cases of anemia, most carriers should have offered coverage. As you are able to control your condition somewhat better and with less medical intervention than other types of anemia, insurers would consider covering you.

Below are a few examples of health insurance underwriting guidelines from various states and carriers in 2012, stating their outlooks for iron deficiency and other forms of anemia.

 

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

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 through Medicaid, CHIP or private policies. Anyone age 65 or older is must also be covered according to law through Medicare. Adults between 19 and 64 also have several options, from buying your own plan to joining a group. Assess the most practical, cost-effective source of insurance and choose the best fit. Even if you cannot afford a private plan, we can help: call 888 803 5917.

 

Employer-Sponsored Coverage

Health plans offered through an employer may be very comprehensive or could be fairly limited. Employer plans have been unable to decline people with conditions since before the health reform law allowed anyone to buy coverage from any insurer, and was therefore an ideal solution for sick people. Now, if your group plan is insufficient, you can apply with any insurer on the individual market. When applying for group coverage, a health plan will not decline anyone with any type of anemia, and there can be no rate increases either, under health reform. These plans usually cover general medical needs and may cover more specific procedures or surgeries. Consult your plan information to find out if a service is covered prior to making an appointment.

 

Medicaid and 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 may qualify in every state, and childless adults with low income are eligible in certain states. Medical assistance covers many medically necessary services. If you have any form of anemia, you should be able to receive coverage for their treatments, as needed.

CHIP, the Children’s Health Insurance Program, 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 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.

 

 

Resources

Let us help you find a great Individual Health Insurance Plan

Medicaid Information

CHIP

Mayo Clinic: Anemia

 

 

Sources:

1. US National Library of Medicine. “Anemia”. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001586/.

2. Mayo Clinic. “Anemia”. http://www.mayoclinic.com/health/anemia/DS00321.

3. Kaiser State Health Facts. “Income Eligibility – Low Income Adults”. http://www.statehealthfacts.org/comparereport.jsp?rep=130&cat=4.