Coronary artery disease, the most common form of heart disease, is the main cause of death in America among both men and women. This is why having heart disease, or any kind of artery or heart problem, makes it increasingly difficult for individuals to obtain health insurance once diagnosed. Coronary heart disease forms when plaque builds up in the arteries to your heart, and is also referred to as hardening of the arteries. However, there are many other types of heart disease, including angina, myocardial infarction, as well as congenital heart defects. Each of these involves a narrowed or blocked blood vessel, and can ultimately lead to a heart attack, chest pain, or stroke if not treated.
As Americans are prone to many of the risk factors, it is no surprise that heart disease is so prevalent. High stress, poor diet, smoking, obesity, and laziness are among the many roots of this family of illnesses. They can be treated and prevented by avoiding such behaviors and not being so American. If the condition escalates, treatment varies according to the specific type of cardiovascular illness. Many types of heart disease are alleviated by lifestyle changes such as eating habits and also can involve medication. Surgery or other medical procedures may also be required to clear the blockages in the heart, such as a coronary angioplasty, or the more invasive coronary artery bypass surgery.
Health insurers have a history of declining those who are extremely unhealthy. Heart diseases are typical causes for an automatic decline, though in certain cases there may be room for an applicant with heart disease. It is yet another instance where the people who need health care most have the hardest time getting coverage. Though the Affordable Care Act has made some changes that are currently helping, insurers still maintain the right to turn away an individual with some form of heart disease, unless they are under 18, which is somewhat rare. If you have any questions about your eligibility or what options you have for coverage, call us at 888 803 5917, or continue reading.
Effect of Heart Disease on Insurability
Heart disease impacts your likelihood of getting health insurance in a fairly negative way. Almost 100 percent of the time, you will be declined coverage or if you are lucky, pay twice as much as a healthy person. The majority of health insurers will evaluate your condition based on your BMI (height to weight ratio), which must be within a normal range, as well as your medical history of surgeries, specific medications, and current treatment. If you take a costly medication, or have had any surgery in the past however-many years your state or the particular insurer looks back, you will be turned down.
This is because health insurance companies are still allowed to be discriminatory, and only want to pay for healthy patients – or in other words, as little as possible. Though these days will cease soon enough, for another year people must abide by the rules of the health insurance company. Below is an example of a health insurer’s underwriting guidelines for various diseases of the heart. Though it is evident that most individuals with heart disease will be declined, there are a few groups in there with a beacon of hope.
Those who manage their condition with an over-the-counter medication or a prescription drug will be subject to a rate increase, but they may be accepted regardless. Depending on each person’s specific lifestyle choices, current health status, and method of treatment, these are the potential outcomes. For those who do make the cut, there is also the possibility of having one of those lovely exclusion periods or elimination riders accompany your plan. These are the insurer’s way of saying, “come on in, but don’t get too comfortable,” as you won’t be able to receive coverage for heart problems for a number of months or years.
Health Insurance Alternatives for Heart Disease
As heart disease are one of the most likely conditions to be declined for coverage, it is necessary to seek out other options for coverage. There are only a few, but hopefully you fall into one of these categories and can make some form of health insurance work for you. This may include insurance through your job, through you have perhaps made that consideration already, or PCIP, or through the ever-generous government of your state. Here is a little bit about the advantages of these other programs, if your condition inhibits you from using our favored variety.
This plan was made for anyone who has a bad history with health insurance carriers. The Pre-Existing Condition Plan does what it sounds like: gives health insurance to people who have been declined for their pre-existing condition. If you have heart disease, you are indeed a candidate for PCIP. This is, of course, if you have no other source of coverage, and have been uninsured for 6 months in a row. If this sounds familiar, then by all means enroll in this plan for the next year until it expires. This plan is government funded, yet private all at once. It acts like an individual health plan, with premiums, coinsurance, deductibles and the like. However, PCIP will not increase your rates for health reasons, only age.
PCIP will not only give you the essentials of health care coverage, but it will also provide the luxury of not excluding benefits relating to your condition. This brilliant concept will soon be adopted by all insurers, but until 2014, there’s PCIP. Though some PCIP members have complained about not having enough provider options, it is important to remember it is a high-risk pool, and it does what it can within reason. Surely they could have organized the program in a more considerate manner, but it is preferable over having no plan at all.
Health plans available through your insurer are typically quite cost-effective, though in recent years their prices have been creeping up. Prices will also climb when a person with heart disease joins the force and everyone’s premiums with go up, but at least you will not be going without insurance. Be shameless, stand up for your condition, and apply for your job’s (or your spouse’s) health plan if you are able to. These plans are recommended for people with conditions as the insurer cannot decline anyone coverage based on their health.
They also cover a variety of services, and will perhaps cover a surgery or two as considered medically necessary. If your life is being threatened, the insurer cannot deny a claim. While all coverage is different depending on the chosen plan, you should be able to access the medical care you need on a group plan. The same range of HMO, PPO, and POS applies to group plans as individual plans, so it is much like what you would have been able to get through the individual plan that would be declining you.
If the previous two options are out of your price range, and basically everything seems out of your price range in this arena, consider Medicaid if you have not already. The Medicaid program in your state will cover your condition, and more, for no cost as long as you meet their income guidelines. Each state is different, therefore it is essential you find out what the guidelines are so you can get coverage as soon as possible.
For heart disease or any other condition, they will be accommodating if you fall into an eligibility group such as parent, child, pregnant woman, elderly, or disabled, and in some states just a regular low-income adult. Medicaid does cover some medications, though you should find out which ones are covered by your state’s plan or otherwise get a discount card for heart disease medications. Surgeries and other medical treatments will also be covered by Medicaid programs as they are needed.
Health Reform & Heart Disease
Anyone with some form of heart disease should be grateful for the Affordable Care Act, as they will be able to get a health plan for the same price as a normal person. In 2014, health insurance companies will have to set their former ways aside and take up a new, nondiscriminatory approach to selling plans. The ACA requires individual health insurers to not increase rates by more than 10 percent, and not exclude services for any reason. The law has also given Americans a new set of preventive care benefits, all of which are free for people with insurance. This includes screenings for diseases for which we might have a high risk.
Many changes have been made to help sick people through the ACA, including the possible Medicaid expansion, which would allow a significantly larger portion of uninsured, low-income Americans to have coverage through the program. States who decide to expand Medicaid will increase the income guideline for existing groups, and add another group: low-income adults without children or disabilities. This will surely help millions of individuals with heart disease. More advancements and adjustments will be made to help people without insurance gain it, as coverage itself will become mandatory. Once everyone is covered on equal terms, it will hopefully be easier to get health care and treat the many illnesses that afflict this country.
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1. U.S. National Library of Medicine. “Coronary Heart Disease”. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/.
2. Mayo Clinic. “Heart Disease”. http://www.mayoclinic.com/health/heart-disease/.