Asthma affects an increasing number of adults and children in the United States each year. According to the American Lung Association, there were 25.9 million total Americans, 7.1 million of which were children, currently living with this condition of the lungs in 2011. Of those who have asthma, 13.2 million experienced an asthma attack last year. Asthma is caused by increased reaction of the airways to a number of stimuli, resulting in swelling and oxygen deprivation. It is a chronic inflammatory condition, which can be life-threatening if it is not treated effectively.
Asthma attacks can be fatal in their most severe forms, while less serious attacks can be triggered by an allergic reaction. Symptoms of an asthma attack include coughing, being unable to breathe, tightness in the chest, and wheezing. As anyone with this condition is aware, asthma needs to be treated constantly. Medicines, doctor’s office visits, and supplies are essential to an asthmatic, which is seen as a risk to health insurers. Any condition viewed as a risk has the potential for an increased rate or a decline, though it depends greatly on the specifics of the company as well as the applicant.
About the Condition
Respiratory difficulty caused by asthma generally occur in attacks, though the inflammation underlying asthma is continuous. An asthma attack is a chain reaction that ultimately leads to restricted airways. The series of events taking place during an attack includes a swelling of the lining, tightening of the muscle, and higher than normal amount of mucus being created in the breathing passage. When an airway narrows, breathing becomes increasingly difficult, resulting in a “wheeze.”
Though there is no cure for asthma, there are ways to prevent the condition from worsening and get it under control. Those who continue to smoke or do not treat their illness properly will experience a much more rapid decline in lung function. As with any condition, making lifestyle decisions on top of using recommended treatments in conjunction with the severity of your asthma will help.
Medications are incredibly helpful for treating asthma, as they target the underlying inflammation in the airways and alleviate or prevent future airway restriction. Controlling inflammation should eventually reduce airway sensitivity and help prevent airway blockage. Asthma medications are divided into two classes, which are anti-inflammatory or controller agents, and bronchiodilators or relievers.
Long-term and short-term medications are available for varying levels of asthma. If you have very severe attacks that put you at a high risk, a continual medication may be recommended. Such continuous treatments may include inhaled corticosteroids, long-acting beta-2 antagonists (LABAs), or leukotriene modifiers. A few brand name long-term prescription drugs may be recognizable as Flovent and Azmacort, which are inhaled corticosteroids, Foradil Aerolizer, a LABA, and Singulair, a leukotrine modifier.
Triggers for asthma attacks or narrowing airways can take place with any irritation of the lungs. It can stem from allergies, viral infections, pollution, or other particles in the air. Avoiding these triggers to the greatest extent possible in addition to recommended medication is preferable for controlling asthma. Every individual who has asthma is triggered by a different set of stimuli, some of the more common sources include the following:
- Cigarette smoke
- Allergic reactions to allergens like mold, pollen, pet dander, feathers, dust, cockroaches, and food
- Colds and respiratory infections
- Exposure to cold air or a sudden temperature change
- Air pollutants both indoor and outdoor, including ozone and particle pollution
- Stress or excitement
Asthma and Health Coverage
Asthma is often considered a pre-existing condition, especially when recently diagnosed. If the diagnosis has occurred within your state’s look back period, you may be declined for coverage or given an exclusion period for up to 12 months in certain states. Depending on the company and their underwriting criteria, asthma is regarded differently. Here is a section excerpted from an underwriting guide for a specific health plan from a national carrier addressing asthma as a risk, and how an agent should respond to their case.
As you can see, the rules vary with age, weight, and severity of the condition. As “D” stands for automatic decline, it is evident that many cases of asthma will not be accepted by this plan. However, this can be helped by not smoking and keeping your weight in a healthy range. Some individuals will experience a premium increase and still be accepted for coverage, though it may be high enough to discourage an applicant from buying the plan.
Whether you experience acceptance with an increased premium, a full decline, or a waiting period before your asthma treatment will be covered, there are ways to get around the system. If your medication is not covered due to an exclusion period, you may apply for prescription assistance with the pharmaceutical manufacturer. Pharmacy discount cards are also available through retail pharmacies if your insurer’s prescription benefits on asthma medications are not available for several months. Also, if you had a health plan in good standings before applying for your current policy, residents of many states can use their prior coverage as a credit towards treatment during the waiting period.
For those who have been declined altogether, there are several options. Firstly, there is the PCIP plan, a high-risk pool designed for all who are declined for coverage. Simply go without insurance for six months and bring your rejection letter from the insurer or documentation of your condition, and the state will set you up with coverage. PCIP has no waiting periods or exclusions on any kind of necessary treatment. PCIP does have premiums, copays, and deductibles, so if this is too costly, you may want to consider applying for Medicaid.
Based on your state‘s income guidelines, you can have any illness or condition, and as long as your earnings are below a certain level, you can receive care. Children have it much easier, as their window for Medicaid acceptance is typically around 133 percent of Federal Poverty Level, while adults can range from 30 to 100 percent of FPL. Also, insurance companies cannot decline a child for having asthma, so if you can afford coverage, they will not be turned away.
If you earn too much or do not fall under a Medicaid category, there is the Medically Needy program. This is offered to anyone who spends so much on health care that they qualify for Medicaid when their medical bills are subtracted from their income. An adult with severe asthma could easily qualify for this program if they earn over the Medicaid limit, and therefore it may be worth consideration.
Choosing a Plan
If you are not in the scenario where you get rejected by a health plan, you want to choose a plan with a comprehensive level of benefits. Makes sure when you select your plan, medications are covered, as well as unlimited visits to your primary care doctor and specialists. Look for a plan with a broad provider network, and if you have a physician of choice already, find out if they are included in the network. Value plans typically will have limited prescriptions, limited office visits, and smaller networks, none of which will help in the case of continuous asthma treatment.
To find out more about a plan’s coverage options, read the brochure and find out everything the plan covers. Also read the exclusions and limitations, though it is some lengthy fine print, for an applicant with asthma, it will be very helpful. This list may tell you if the insurer places any waiting periods on coverage for people with asthma or other ways they treat such applicants. It is equally important to read an insurer’s list of providers, which you can usually locate through their website if it is not offered to you during the application process.
Not all plans with enough benefits to cover your needs are incredibly expensive. When you get a quote for yourself, and compare prices and plan options, it is not always as costly as you might think. Though it depends heavily on the region, a solid, comprehensive plan may exist near you for a decent price. If you have trouble finding a plan that fits your needs, call one of our seasoned agents who will provide the best assistance possible at 888 803 5917.
1. American Lung Association. Asthma in Adults Fact Sheet.
2. Mayo Clinic. Asthma.