Bob and Mary (not their real names) are a middle-aged couple living in New York, and – despite their desire to move to Nevada and retire – they’ll stay in New York for the time being. The couple have decided to put their move on hold, not because they couldn’t find an affordable home or because the job market is tight, but because they’re still looking for health insurance.
The problem? Mary was diagnosed with multiple myeloma, and recently completed chemotherapy. If the couple move to Nevada, their tri-state health plan won’t cover them, and because of Mary’s pre-existing condition, they haven’t been able to find a single plan to ensure that she continues to get essential care. (Neither has employer-sponsored health benefits.)
The federal temporary Pre-Existing Condition Insurance Plan (PCIP) in Nevada isn’t an option, as Mary hasn’t yet met the requirement of being without insurance coverage for six months, and Nevada doesn’t have a state risk pool independent of the PCIP. So Bob and Mary are in limbo – and still in New York – as they hunt for a coverage option.
The couple’s story – pulled from a recent request for assistance to the Patient Advocate Foundation – isn’t isolated. The PAF, a national nonprofit that provides case management for Americans with health insurance access issues, often receives requests from people considering relocation to a new state.
“We hear from individuals who are confused about what will happen to their coverage if they move to a new state,” says PAF Spokesperson Erin Moaratty. “And it’s not surprising, considering that each state offers differing consumer protections for policy holders.”
Internet message boards and Q&A web sites are also dotted with questions about what happens to individual health insurance coverage when the policyholder moves to a new state. And the answer – usually – is that it depends on the carrier, and on each state.
Consumer protections vary by state
Cheryl Fish-Parcham, Deputy Director of Health Policy at the nonprofit Families USA, says that a big part of the uncertainty facing policyholders in the non-group market is that each state protects policyholders differently.
Until 2014 – when reform provisions of the Affordable Care Act take effect – “consumers may face problems buying plans on the individual market, depending on whether the state where they are moving has enacted any laws to protect them,” Fish-Parcham says.
Some states, Fish-Parcham says, are guaranteed issue states, requiring some or all insurers to sell to residents regardless of health status. In six states – Maine, New Jersey, New York, Vermont, Washington and Massachusetts – all individual market insurers are required to guarantee issue on all individual plans the insurer sells to all applicants. (Massachusetts guarantees issue during an open-enrollment period.)
The bad news? “Once you get into one of the plans that has to accept you, states have differing rules about whether the new plan has to immediately treat all of your health conditions, or whether the plan can make you wait a certain number of months for treatment of a pre-existing condition,” she says.
“In some states, if you had previous coverage and you signed up for your new health plan quickly, then that is taken into account and will reduce or eliminate the waiting period. But that isn’t so everywhere.”
Individuals who can’t get approved for individual coverage or who can’t afford it have found hope in states offering high-risk insurance. The aforementioned PCIP is already providing some relief, but – as in the case of Bob and Mary – applicants must have gone six months uninsured.
Thirty-five U.S. states operated high-risk pools before the PCIP began enrolling, and – again, depending on the state – those risk pools might be an option. Amie Goldman, Chair of the National Association of State Comprehensive Health Insurance Plans (NASCHIP), says individuals who have health coverage prior to moving should check with the risk pool in their new state of residence to see whether that coverage is considered creditable coverage, which could decrease a risk pool’s waiting period.
In other states, state-sponsored risk pools might not be the answer for new residents. Pools in some states have pre-existing condition exclusion periods, while some are just plain expensive – with premiums 125 percent or more of standard market premiums.
Children, meanwhile, have already benefitted from the Affordable Care Act’s provisions, which prohibit carriers from denying them a policy based on a pre-existing condition. But with those provisions, families face different rules in each state regarding open-enrollment seasons for children.
Look before you leap
Much of the uncertainty of moving to a new state is expected to vanish when provisions of the Affordable Care Act take effect. “Life will be much simpler in 2014 when health plans have to accept people and charge them fair premiums no matter their health status,” Fish-Parchman says.
But until then, the best advice for those individual policyholders contemplating a move across state lines is simple: Look before you leap.
“Definitely check with your own health insurance plan to see if it has arrangements with a plan in another state that will guarantee you coverage,” Fish-Parchman says. Call the number on your insurance card to learn what, if any, benefits you will be entitled to once you move, including any paperwork you may have to fill out, changes in the premium or plan, and how you access it.
“You should also check with the state insurance department in the state where you are relocating to see what protections they have for people in your situation,” Fish-Parchmans says.
Ask plenty of questions
Here are a handful of questions you’ll definitely want answered before you decide to move out of state:
- Can I be refused health insurance because of a pre-existing condition? And if I can be refused, how long will it be before I qualify?
- If I can stay with my existing plan, will I be dealing with another branch of the company and will the policy or rules be different?
- What geographical region does my HMO cover? Can I keep my PPO coverage and pay an out-of-network rate? If so, how much higher will my premium and out-of-pocket expenses be?
- If I can stay with my existing plan, is there a time frame during which I must enroll in my new state to get continuous coverage?
- Will I be covered for urgent and emergency care even if my entire original plan does not roll over in a new state?
- What deadlines do I need to watch? (Some health plans will offer protections if you enroll promptly after losing your other coverage, but won’t help you if you wait, Fish-Parchman says.)
If you’ve leapt already
If you’ve already moved, you have a pre-existing medical condition that would cause an insurer to deny you coverage, and you’ve been uninsured for at least six months, check out the Pre-existing Conditition Insurance Plan created under the Affordable Care Act.
If you’ve moved, applied for a policy and been denied coverage, you might consider an appeal. It’s easier than ever to appeal a carrier’s decision, thanks to new provisions of the Affordable Care Act.