Epilepsy encompasses the diagnosis for many different types of seizures, recurring in individuals with the condition. It is the fourth most common neurological disorder in the country, after migraines and Alzheimer’s. Those who have been diagnosed as epileptic may have had more than one kind of seizure, but they must have had seizures more than once. Seizures are caused by abnormal electrical activity in the brain, creating an involuntary physical reaction, changing the body’s movement or function, sensation, awareness, or behavior.
Affecting about 2.3 million people in the U.S., epilepsy most commonly affects people who are very young or old. According to the Centers for Disease Control (CDC), about 10 percent of Americans will have a seizure during the course of their life, and about 3 percent will be diagnosed with epilepsy by the age of 80. Treatment for epilepsy is still experimental, varying intensely based on the patient. Medications, such as anti-convulsants are typically prescribed for daily use to prevent seizures from recurring. Despite its prevalence and medical advancements, epilepsy remains one of the least understood major chronic illnesses.
This condition can also be caused by serving in the Armed Forces, when head injuries result in Post-Traumatic Epilepsy. Brain injuries can often go undetected as they are not outwardly visible, though many soldiers have reportedly experienced seizures after contact with powerful explosions. This disorder can develop months or even years following the trauma, and result in subtle seizures accompanied by other symptoms such as memory loss, and changes in behavior and/or awareness.
Treatment & Prevention
Epilepsy requires a variety of tests and treatments, all of which are a shot in the dark and will have varied results based on the patient. The most common ways to treat and monitor the condition include EEG tests, which if abnormal, will usually be an indicator of necessary follow-up. Individuals with other neurological abnormalities (typically children) are at higher risk for further seizures, the chance of which can be up to 60 percent. If the condition is proven as recurring, after three or more seizures, then a doctor will usually prescribe and anti-epileptic medication.
Ways to prevent seizures include taking prescribed medication without missing a dose, as suddenly discontinuing use could result in potentially life-threatening non-stop seizures. Also, getting a healthy amount of sleep is recommended for epileptics, in addition to being wary of alcohol consumption. Making sure you do not mix any over-the-counter or other type of medication that could negatively interact with your anti-seizure drugs is important, as well. Still, besides medication, sleep, and being careful about what you put into your body, prevention is relative to each patient.
Epilepsy and Individual Health Insurance
The individual health insurance market is known for making is difficult for people with health problems to receive approval for coverage. However, do not lose hope or decide against applying, because underwriting varies based on carrier and state. Though it is frustrating to not know if you will be declined before applying, the possibility remains that you will not get completely locked out of the system. Insurers who accept epileptic plan members may issue an exclusion period, where they will not help pay for your medications or EEG tests. Certain states can also attach an elimination rider to your plan, which states your health plan will never cover care, which is unfair and somewhat pointless for a person with epilepsy.
Fortunately, this is only a problem for the next year, as the health reform law has addressed declining conditions rather firmly. Anyone who has a pre-existing condition from January 1, 2014 onward will be able to purchase a plan from any insurer without exclusions or any other limits placed on their access to care. All care that a person requires will be covered by their health plan, according to federal law. This holds true for the plans we sell at East Coast Health Insurance, as well as the plans the government will create in Exchanges.
Presently, individual and family coverage is still subject to exclusions, increased monthly premium rates, and decline for epileptics. Because the majority of individuals with epilepsy are children, they will have no problem being covered, as laws already enforce that every insurer must accept children under 18 regardless of their health. Below is an example of the process insurance companies use to determine eligibility and pricing for a health plan applicant. This is an excerpt from a carrier’s underwriting guidelines related to epilepsy, which indicates they will increase rates significantly or decline an individual based on their age and the recurrence of their seizures.
More Coverage Options
If individual health insurance is not available to you, or unreasonably priced, because of your epilepsy, there are several alternatives. The most popular type of coverage in the U.S. continues to be group insurance, which is offered through an employer. Workers and dependent children or spouses can utilize this benefit and not experience without facing adversity. Also, if that is not an option, public coverage is offered through your state’s Department of Health and Human Services (or equivalent organization). Those who are age 65 or older with epilepsy can receive government-funded benefits as well, through Medicare.
Group Health Insurance
In the event that you, your spouse, or parent(s) receive employee health benefits through the workplace, it is worth trying to use. Though these plan seem to be increasing in cost over time, they continue to be the most common form of health insurance in the country. These plans do not have the strict underwriting guidelines of an individual plan, and they will cover the necessary testing and prescriptions an epileptic requires to function normally.
Employers typically offer HMO plans, which connect you to a specific network of providers for all of your health care services. This can be limiting in certain regions if a specialist or certain facility is needed for epilepsy tests and treatment and is not part of your HMO. If you do have access to employer benefits, make sure you check the health plan’s provider network for more information.
Medicaid & CHIP
Each state offers a Medicaid and a Children’s Health Insurance Program (CHIP) for low-income children, families, pregnant women, and aged or disabled persons. Income restrictions are varied in every state, though if accepted, benefits begin immediately and provide coverage for prescriptions, preventive care, and all medically necessary treatment. Children up to age 18 with a family income over the limit for Medicaid can obtain coverage through CHIP, which covers the same health care services.
Medicaid also has a program called Medically Needy, for those who spend enough on health care to be considered eligible for assistance. This also varies by state, and it will provide assistance with your medical bills but not provide full Medicaid benefits or act as a comprehensive health plan.
PCIP
While we await the first of January 2014, a quick fix has been established by the ACA to provide coverage to people with pre-existing conditions. The Pre-Existing Condition Insurance Plan is state-sponsored, though unlike Medicaid there are payments involved. The positive aspects to the program are that no types of prescriptions or medical services will be excluded if they are medically necessary, and will be available from the day your benefits become effective.
PCIP acts like a private health plan, with cost levels based on an applicant’s income so to remain in an affordable range. In order to apply, you must have proof of your condition from a doctor or a letter of rejection from a health plan, and be uninsured for at least six consecutive months prior to applying.
Medicare
Those who are age 65 or older are most likely aware that they have access to Medicare. Individuals with epilepsy can receive coverage for their prescriptions through Medicare Part D plans, and health care services to maintain wellness and normalcy through regular Medicare. As the Affordable Care Act also modified the Medicare system, more elderly people with epilepsy should be able to receive a better quality of care for their condition. ACOs and medical homes are attempting to streamline care for Medicare members, eliminating unnecessary treatment and keeping patients more healthy more often.
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