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Pre-Existing Conditions Program: Information for Uninsured Migraine Patients

Starting in 2014 insurance companies will no longer be permitted to deny coverage to adults with pre-existing conditions or charge them higher premiums. Until then people living with a health condition they were diagnosed with before enrolling in a health insurance plan (like migraines) are left out in the cold. To help provide coverage for people caught in that situation the 2010 Affordable Care Act offers a temporary Pre-Existing Condition Insurance Coverage Program for people who cannot get insurance coverage and don’t have coverage through an employer or spouse.

Depending on which state you live in you will be covered under a state-run or federal-run program. Some states will run their own programs, while others will allow the federal government to run the program for them. For instance, in my home state of Kansas the state is running its own program through the Kansas Health Insurance Association (KHIA State Pool). The only requirements for eligibility are (1) you’re a legal US resident, (2) you’ve been without insurance coverage for at least six months and (3) you have a pre-existing condition. To satisfy the third requirement you can either have your doctor certify that you have been diagnosed with one of a number of specific conditions or submit a denial letter from an insurance company. Upon their receipt of your documentation you are immediately covered. It’s really quite straight forward.

Plan members pay a monthly premium and have access to a full range of medical providers and services. The federal law requires their premiums to be the same as those paid by other people buying health insurance through regular insurance programs.

Unfortunately, as you hopefully just noticed, to be eligible to apply you must have been without health insurance coverage for six months. I find this requirement extremely frustrating. This kind of delay leads to catastrophic consequences for people’s health and financial stability. If you have a pre-existing condition you most likely need treatment for that condition. After all, that’s why insurance companies have refused to cover you: you’ll be too expensive. A program that’s supposed to fill the gap while we wait for the law prohibiting insurance companies from discriminating on the basis of pre-existing conditions to take effect leaves yet another gap for people who already have compromised health. A year for your condition to go largely untreated. This not only harms the individual, it drives up the cost of health care for everyone by leaving treatable conditions undertreated, creating a need for more expensive interventions down the line. The program is certainly better than nothing and I get that they are discouraging people from dropping existing coverage to enroll in these programs, but I wish its requirements were more reflective of the needs of people living with pre-existing health conditions. For us six months can be a really long time.

For more information about the Pre-Existing Conditions Program, including state-specific program information, please visit: Pre-Existing Conditions Insurance Program.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • tucker
    8 years ago

    We dealt with this years ago when my son was in the hospital for his first asthma attack then my husband lost his job. Cobra was prohibitively expensive even 8 yrs ago. So we decided to go with an individual policy. At first BCBS wouldn’t insure a 3 yr old, then they gave him a policy that cost more than the family policy for the rest of us and it didn’t cover asthma. I can’t imagine what we’d do now – I have several “health problems”, he’s still got asthma attached to his chart and now my other son has migraines. We’d be dropped like rocks if my husband lost his job of 6 yrs w/ great benefits. I only work PT so no benefits. I don’t think all these people who are whining about “Obamacare” know that some of the great things that have come out of it could very well make or break them one day when they are on the other end of the “without insurance” spectrum.

    BTW, this also applies to life insurance. I got asked all kinds of questions b/c of the topomax and had to prove it was for migraines and not seizures.

  • Diana-Lee author
    8 years ago

    $600 is a lot of money to people like us! I’m so sorry you’re dealing with that.

  • LeelooMinai
    8 years ago

    That 6 months without insurance before you can qualify is, indeed, frustrating. I would drop my husband’s supposedly “great” insurance in a heartbeat if I knew I could rely on a program like this to help me make it through til 2014.

    I may have fewer migraines after my PFO closure, but it doesn’t mean I don’t need more than 4 triptans a month!

    Our “great” insurance co. is knocking our door down with threats to stop coverage of medications unless I enroll in their mail-in pharmacy, which requires me to pay 3 months’ copay in advance. I’m sorry, but I do not have $600 laying around to pass on to this pharmacy, nor do I want to deal with people on the phone who do not know me or my problems. I didn’t even know a pharmacy could be out-of-network for insurance companies!

    It just seems every which way we turn we are out of satisfying options. I cannot believe our country allows this sort of bullying.

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