Migraines and Health Insurance

Migraine headaches are characterized by an intense throbbing or pulsing in one area of the head, and is typically paired with other symptoms including nausea, vomiting, and an extreme degree of sensitivity to light and sound. These severe headaches are sometimes preceded by warnings such as light flashes, blind spots, and tingling in the arms or legs. The intense amount of pain caused by a migraine can extend for several hours or even days.

This type of headache is caused by a combination of blood vessel enlargement and the release of chemicals from the nerve fibers surrounding these blood vessels. While having a migraine, the temporal artery enlarges, resulting in a release of chemicals that lead to inflammation, pain, and further enlargement of the artery. Over 28 million people living in the U.S. experience these tremendously painful headaches, a larger majority being female.

Many different factors may induce a migraine, though some individuals who have them are still unable to identify what triggered their massive headache. Some triggers may include allergies, overwhelming lights, sounds, or odors, physical or emotional stress, smoking, fasting, alcohol, certain foods, and changes in sleep patterns. However, triggers are not always the cause of a migraine, and avoiding them does not ensure a migraine will not occur.

Migraine treatment and prevention is centered around avoiding triggers, controlling symptoms, as well as using medications. While some can effectively use over-the-counter medications such as Excedrin, others may not respond and decide to use a serotonin antagonist, or even an antidepressant  to reduce migraine symptoms. Other remedies and prevention includes a range of solutions for avoiding triggers such as herbs and vitamins, Botox, surgery, prescriptions, and exercise.


Private Health Insurance for Migraines: Past and Present



Health insurance coverage for individuals and families can help those who are self-employed, or otherwise have no source of group insurance. Treating migraines will be significantly more smooth a process and more financially possible if you are covered. Although it is not a chronic or life-threatening illness, migraines can still prevent individuals from living a normal, full life, and require that some action be taken to prevent or control attacks. Testing or consulting with a doctor may be needed for some individuals on a regular basis in order to maintain normalcy, which is where a health plan can be a positive contribution.

Under health reform, your condition cannot get in the way of you obtaining coverage. All insurers must approve your application and cannot rate you up for coverage as they could with individual plans previously (see example below). Additionally, you have more options due to the health care law, including health insurance on the individual market — both private plans or through your state’s health insurance exchange — and the group market, where rates can’t increase for the group anymore. The Affordable Care Act also establishes that individual plans must cover certain services, called essential health benefits, with every comprehensive plan. Employers are not required to do so, however.



Here is a little bit of background on how private insurance worked before the health care law, as it pertained to migraines. Certain health insurance companies did not take migraines as seriously as other conditions, which means the option of private insurance may have been open, depending on the carrier. Accounts of individuals being declined for having a history of migraines have been documented, though these incidences were contingent upon the company and the state.

One of our national carriers’ antiquated underwriting criteria from 2012 features migraines on their list of conditions with risk associated, and in turn, how an agent should rate up someone with migraines. Based on the severity and frequency of an applicant’s migraine headaches, they could not receive any rate increase whatsoever, or pay almost double a normal premium. It also depended on how the applicant was managing their migraines, and if they were taking recommended measures to control them from recurring.


In the event that you did get turned away for your migraines, you could try another carrier, or fall back on PCIP, the temporary high-risk pool created by the ACA. So long as you did not have any sort of insurance coverage for the six months preceding your application date and had adequate documentation of your migraines’ severity, or a letter of declined coverage from a health insurance company, PCIP was available through January 2013. Though administered by state and federal government, PCIP was administered by private insurers and would not increase your rates based on your health status. They would also cover any necessary treatment and medications you may have required without imposing an exclusion period or elimination rider. Npw that all insurers accept all applicants, it is unnecessary for the Pre-existing Condition Insurance Plan to exist, and coverage can be purchased with any company.


Public Coverage for Migraines

Low-income individuals who have migraines may be eligible for government-issued coverage such as Medicaid, or if you are 65 or older, you will be covered under Medicare. Some low-income elderly Americans qualify for assistance through the Medicaid-Medicare dual eligible program. Qualifying for these programs involves an income screening, being of a certain age, and fitting into a group of eligible individuals. Children with migraines are accepted, as well as certain adults in many states. Adults must have children and an extremely low income to qualify in some states, but others offer coverage to childless adults and parents with income up to the current poverty level. Adults with disabilities also qualify for Medicaid, or Medicare if the disability is permanent. These programs cover the majority of services and medications needed to treat migraines, and may make exceptions based on your condition if they do not cover them already.

The Affordable Care Act helps modify this eligibility criteria, opening the program up to non-disabled adults, who are not required to have children. This enables many Americans who do not have the means to purchase a health plan to get the coverage they need, as long as they earn up to 138 percent of the Federal Poverty Level in states where Medicaid has expanded.

In addition to Medicaid, exchanges allow more low-income individuals to purchase health insurance with financial assistance from federal subsidies. Tax credits are granted to people who earn more than the Medicaid limits up to four times the poverty level. A dramatically increased number of people with migraines and other conditions will be able to receive coverage they had not been able to previously due to this provision of the health care law.



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