You are most likely going to have to join the California high risk
pool, known as the "Major Risk Medical Insurance Program." However,
in order to be eligible, you must first either be denied coverage or
be offered coverage for a premium that is higher than that of the
program. Therefore, your first step will be to contact an insurance
agent and attempt to purchase individual insurance. Of course you
will need to disclose your pre-existing condition. I suggest an
independent insurance agent since there is a chance someone might
offer you coverage, depending upon the nature of your pre-existing
condition.
Once you have been turned down or offered an excessive premium, then
you can apply to the Major Risk Medical Insurance Program. There may
be a waiting list, but the program has been structured to shorten it
considerably. After you have been on the program for 36 months, you
are forced to leave it, but you will then be guaranteed acceptance
into guaranteed coverage that health plans are required to offer in
the individual insurance market.
The premiums range from 125% of standard average individual coverage
to 137.5%, based on the plan you select.
Sincerely,
Wonko
Sources:
"State Coverage Matrix" AcademyHealth
http://www.statecoverage.net/highriskchart.htm
"The Major Risk Medical Insurance Program (MRMIP) provides health
insurance for Californians who are unable to obtain coverage in the
individual health insurance market. Read More.. For an application:
call toll free 1-800-289-6574."
"California Managed Risk Medical Insurance Board" State of California
(2005) http://www.mrmib.ca.gov/
"The Major Risk Medical Insurance Program (MRMIP) provides health
insurance for Californians
who are unable to obtain coverage in the individual health insurance
market. The majority of
subscribers are between the ages of 40-64, and 58% are women. People
enroll in the program
because they have been rejected for coverage by an insurance carrier
or health plan due to a
pre-existing condition. After 36 consecutive months in the program,
subscribers are required to
leave MRMIP, but they leave with a guarantee of coverage from plans
selling coverage in the
individual insurance market. Services in the program are delivered
through contracts with health
insurance plans. Californians qualifying for the program, and for the
guaranteed issue coverage
that follows MRMIP coverage, participate in the cost of their coverage
by paying premiums. The
State of California supplements those premiums to cover the cost of
care in MRMIP. The State
shares the cost of post MRMIP coverage with health plans that provide
the coverage. MRMIP's
subsidy is funded from tobacco tax funds. For an application: call
toll free 1-800-289-6574.
Please click the following link for MRMIP Handbook."
"Major Risk Medical Insurance Program" http://www.mrmib.ca.gov/MRMIB/MRMIPDoc.pdf
The application is available here: http://www.mrmib.ca.gov/MRMIB/MRMIPBRO.pdf
You are eligible:
"If you have been denied individual
coverage within the previous 12
months. A letter/copy of a letter
from a health insurance carrier,
health plan or health maintenance
organization denying individual
coverage within the last 12 months
must be submitted with your
complete application. Insurance
denial notifications received through
the internet that do not provide the
reason for denial and the applicant?s
name will not be accepted.
If you have been offered, in the
previous 12 months, an individual,
not a group, health insurance
premium in excess of your Major
Risk Medical Insurance Program
subscriber rate. A letter/copy of a
letter must be submitted with the
complete application indicating that,
within the last 12 months, you have
been offered by a health insurance
carrier, health plan or health
maintenance organization, a
premium for the subscriber and/or
their dependents (when applicable)
in excess of the MRMIP rate for the
subscriber and/or their dependents.
Note: Letters from agents/brokers
indicating that an individual is unable
to secure adequate private coverage will
not be accepted as documentation
for eligibility." |
Clarification of Answer by
wonko-ga
on
11 Oct 2005 15:05 PDT
The only information I was able to find about a sliding scale premium
related to a Working Disabled Program in California: "Balance Budget
Act of 1997 California Eligibility Rules and Policies" Centers for
Medicare & Medicaid Services
http://www.cms.hhs.gov/twwiia/eligCA.asp?state=CA
If you have children and your earnings are 100% or less of the federal
poverty level, you may be eligible for California Medicaid: "The
California Medicaid Program at a Glance" The Henry J. Kaiser Family
Foundation (July 2004)
http://www.kff.org/statepolicy/upload/The-California-Medicaid-Program-at-a-Glance.pdf
You only have to be turned down once in a 12 month period to be
eligible for the California high risk pool. There is no way for you
to get insurance of any kind without applying for it. While it is of
course not ideal to be turned down for health insurance, you cannot
obtain health insurance without applying for it, and the California
high risk pool requires it. I suggest you contact an independent
insurance agent and have him or her help you determine which company
would be the most likely provide you with coverage and apply there.
If you get coverage, great. If not, you are then eligible to
participate in the high risk insurance pool. Once the high-risk
insurance pool ends, then you can get insurance through one of the
approved plans.
Unfortunately, even for healthy people, individual health insurance is
very expensive. A pre-existing condition makes it much more so, if it
is even available. California caps the premiums for the iris poll at
a considerably lower rate than many states, so that is beneficial to
you. Furthermore, as a self-employed person, you can deduct health
insurance premiums from your taxes if you generate sufficient profit
from your self-employment activities.
Best of luck.
Sincerely,
Wonko
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