HPV and Health Insurance


With the increasing number of individuals, women in particular, infected with HPV (Human Papillomavirus) in America, it is important to know what you can do to take action. As one of the most common sexually transmitted diseases, there are about 6.2 million people living in America who acquire HPV each year. Currently, there are approximately 20 million people infected with this STD. HPV is a broad range of viruses that infect the skin, with over 100 different variations of the disease. The greatest concern with HPV is that left untreated, it may lead to cervical cancer and other types of cancers in both men and women.

Symptoms of HPV are often undetectable, which makes this disease more difficult to track. However, the good news about this particular condition is that over time, a healthy immune system can clear the virus on its own or at least suppress it. In certain cases, for which the medical system has been working diligently to stress prevention, it can lead to genital warts and abnormal cells causing cancer. Many women have received an abnormal Pap test requiring them to return for further testing, colposcopies, and may use Gardasil injections periodically to prevent the illness from worsening.

Fortunately, the majority of high-risk HPV cases do not lead to cancer. The immune system will resolve any further development if well maintained, as the cancer takes 5 to 10 years, sometimes longer, to actually develop once abnormal cells are discovered. Regular Pap smears are an essential part of eliminating and controlling HPV, which is now a free preventive service for insured women. Whether you have public coverage through Medicaid or individual health insurance, this type of care will not cost anything extra, as it is now acknowledged as a pertinent exam.

 

How HPV Affects Insurability: Past and Present

 

PRESENT

Health Reform and HPV

Prior to the health care law, many individuals were denied coverage due to their HPV or abnormal Pap, which has since changed. Insurers were free to underwrite as they liked until 2014, when all individuals with any history of a condition on any scale became eligible for coverage. This is one of the most relevant and helpful moves the the Affordable Care Act has made for Americans. Whether people decide to purchase coverage through an established carrier such as UnitedHealthOne or Kaiser Permanente on the private market, or find the same companies on a state Exchange, there will be no exclusions, elimination riders or declines permitted by law.

Individuals who have a low income may be eligible for coverage through Medicaid, which accepts adults without children, the primary group HPV would cover. Though Medicaid expansion is optional, the states who decided to implement the changes give adults access to care if their income is up to 138 percent of the Federal Poverty Level. Also, more adults with children are able to receive coverage through Medicaid, as the income requirements increased in certain states under health reform.

Those who have an income above Medicaid limits yet cannot afford to buy private coverage may be eligible for a subsidy through the state health Exchange. Subsidies will help individuals pay for coverage through the health insurance exchange, the government’s answer to private health plans. Exchanges will be set up in each state, with the same format for health plans as a basic plan you would receive from any health insurer, with the same exact coverage from place to place and insurer to insurer. Each Exchange is required to have a set of “essential benefits,” which covers at least ten of a number of common health care categories.

 

PAST

Though one of the most common conditions in the United States, it is also one that was likely to result in a decline from many private insurers before health reform. One of our individual carriers with more lenient underwriting guidelines in Florida (featured below) made sure they asked an applicant for more information before declining them coverage. Other health factors, medical history, and preventative measures taken all affect whether or not this particular insurer will decide to rate up an applicant with an abnormal Pap or decline them entirely. This insurer would ask for additional information according to their 2012 guidelines, though not necessarily decline an individual for coverage.

HPV that results in genital warts is likely to be an automatic decline for coverage, as it is an expensive and chronic condition to treat. According to the underwriting guidelines for one insurer, any male or female over age 19 will be turned away if they have current breakouts or current abnormal Pap smears. Luckily, the majority of cases are those occurring in women with an abnormal Pap who do not have genital warts, and are at risk for cervical cancer, which was not heavily discriminated upon by this insurer, at least.

Below is an example of the pre-health reform guidelines for one insurer we represent for abnormal Pap tests, as HPV diagnosis itself is not mentioned. First, we will show the unfortunate results of non-coverage for individuals with warts, and secondly, the good news for those who do not. The good news is that this is simply a reference, and these rules no longer apply.

 

Health Insurance Options for HPV

 

Individual Health Plans

Regardless of the form your HPV may take, you have multiple outlets for obtaining coverage to treat your condition. Depending on your state regulations and the underwriting guidelines of the carrier with which you apply (may we suggest Aetna for their flexibility, if available), you may be able to purchase an individual health plan.You will not be declined for individual coverage or have your premiums go up based on your health status or medical history. Additionally, immunizations, OB/GYN office visits, diagnostic testing, and preventive care will all be covered through a private plan. As one of the most common diseases of the moment, it is also one of the larger focal points among health care researchers, which means your health plan will help you get the care you need for HPV.

 

Employer Plans

If you have the option of receiving a health plan through your employer, review the policy and find out if it’s worth your time. It may not have enough benefits, or ask you to pay a higher premium than you want to, due to a lesser contribution from your employer. Employer-sponsored plans will not refuse anyone based on their condition, though coverage may be limited depending on the type of plan the employer has chosen. Preventive care and treatment should not be restricted, however, which means the group plan should pick up the tab for the most common treatments for HPV, such as Gardasil and Pap tests.

 

Public Health Plans

Those who have a low income and have been diagnosed with HPV may qualify for a free health insurance program such as Medicaid, or CHIP if they are under 18. In the rare case that a person infected with HPV is age 65 or older, they will be eligible for Medicare, and will already be unable to receive benefits through a private health plan. Medicaid eligibility differs based on the state in which you live. A few states have expanded their programs to include adults without children, who are not disabled, yet the majority of state programs still only cover low-income children, families, pregnant women, and disabled persons. Income is the main factor in determining eligibility for Medicaid, therefore it is necessary to check your state’s regulations.

Medicaid and CHIP both cover the same services, including preventive care, major medical, and the testing and prescriptions needed to treat HPV. STD screening, Pap tests, immunizations, well-woman care, and prescriptions are all covered by these programs, and most also include educational and counseling services to help inform members about their illness and how to properly treat them.

Resources

Individual Health Insurance Quotes

Centers for Disease Control: HPV information

Medicaid Information