What To Do When You’ve Lost Your Health Insurance

If you have lost your medical insurance or your application for health benefits has been denied, you may be very frustrated, but this article is intended to give practical solutions to your dilemma. You have recourse and other options to get medical insurance coverage. Depending on your most recent prior health insurance coverage, your options will vary. Choose the section below that most accurately describes your situation.

What if I was previously on a Group Health Plan?
If your most recent coverage was a group or employers’ plan and you lost coverage due to age restrictions or job loss, for example, you may qualify for one of the following options:

  • Individual/Family Coverage: must be approved by underwriting
  • COBRA: up to 18-36 months, approval not subject to medical underwriting
  • Conversion Plans: approval not subject to medical underwriting, available through Kaiser Permanente only if your prior group insurance was through Kaiser Permanente
  • Medicare Coverage: if you are at least 65 or qualify for Medicare by other means

Kaiser Permanente Individual and Family Health Insurance (call 1-800-514-0958) is the most cost effective option; however, eligibility is based on medical underwriting. If you have a pre-existing condition that is severe, recurring, or chronic, a better option may be COBRA or the Conversion Plan (call 1-800-634-4579). Neither COBRA nor the Conversion Plan require medical review, but the premiums tend to be more expensive. If you are considering becoming a business owner, you may also qualify for your own group insurance. Get group health insurance quotes online or call 1-800-514-0958 for details.

What if I was previously on COBRA coverage?
If your last insurance plan was through COBRA, and you finished the maximum coverage period allowable (18 months for an employee or 36 months for a dependent), you may be eligible for HIPAA Coverage: eligibility is not subject to medical underwriting.

If you are reasonably healthy, consider an Individual and Family Medical Plan, which offers more affordable premiums. If you have a pre-existing condition that is severe, recurring, or chronic, then HIPAA may be the better option since you cannot be denied for health reasons. The HIPAA premium may be comparable to your COBRA premium. You must apply within 63 days of when you lost COBRA to be eligible for a HIPAA Plan. To apply for HIPAA coverage, simply apply for an Individual and Family Health Plan and mark that you are interested in a HIPAA Plan at the end of the application.

What if I was on a Kaiser Permanente specialty plan, other than group insurance or COBRA?
If you were on the Kaiser Permanente Child Health Plan or the Steps Program and lost coverage, whether voluntarily or involuntarily, here are your options:

  • Individual/Family Plan: subject to medical underwriting
  • Conversion Plan: not subject to medical underwriting

Both will be more expensive than the plan you were on, however, the Kaiser Permanente Individual and Family Plan is the more affordable option. For individual coverage you will have to meet the requirements of medical underwriting and you may be denied for pre-existing health conditions.

What if my application for a private health insurance plan was denied due to pre-existing medical conditions?
If your application was denied due to pre-existing medical conditions, consider the following alternatives:

  • Group Health Insurance: The quickest and, oftentimes, the most cost effective option is a Small Group Insurance Plan. To qualify, you must be a business owner and have at least two people working at the company. If you are married, you and your spouse can satisfy the two-people minimum requirement. Group rates tend to be pricier than the Individual and Family rates, but at least, you cannot be denied for medical reasons. Call 1-800-514-0958 for more information or to obtain quotes.
  • Appeal: With most carriers you have the option of appealing the denial. If you were denied for a Kaiser Permanente Individual/Family plan and disagree with the underwriter’s decision, you can appeal. You will need to submit the request for reconsideration in writing. Follow the instructions on your denial letter in order to submit an appeal.
  • Reapply: If your Kaiser Permanente Individual/Family insurance application was denied at least six months ago, you may reapply. The wait time for reapplication will vary depending on the severity of the medical condition. Note that if the condition you were denied for has not improved, it is best to wait until significant improvement has been made.
  • AIM: If you were denied due to pregnancy, contact AIM (“Access for Infants and Mothers”), which is administered by the State of California. AIM can be reached at 1-800-433-2611.
  • MRMIP: If none of the above is workable, contact MRMIP (“Major Risk Medical Insurance Program”), which is another state-regulated program. Their telephone number is 1-800-289-6574.

Finding a replacement health insurance plan can be daunting. You may end up finding better coverage than you had before. Or, you may have to make sacrifices as far as premium or benefits to keep coverage at all. In light of the frustration you may have faced from losing your medical insurance coverage, we hope the above information will aide you in acquiring a new health plan that will work for you.


Comment from Zvi Shahak
Time: October 21, 2010, 8:38 am

If a person lost their insurance from work and cannot afford the cost of cobra (no employment, mental and physical disability) and the person needs the coverage continually. what are the options?

Comment from Esmeralda Mercado
Time: October 22, 2010, 11:57 pm

As COBRA is cost-prohibitive, please consider calling MediCAl at 1-888-747-1222, or the Foundation for Health Coverage Education at 1-800-234-1317 (website: coverage4all.org) to explore your other options.

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