If you have a pre-existing health condition, you may be worried about what will happen if you must change health plans or buy a new insurance policy. Fortunately, in some cases, you may be able to avoid a gap in coverage.
There is hope, though, especially for people who have job-based health coverage. Job-based health plans must "credit" you for each month of prior continuous creditable coverage. This "credit" offsets the pre-existing condition exclusion period. So if you were covered under a job-based plan for 9 months before changing jobs and immediately enrolling in a new plan, you must be credited for those 9 months of prior continuous creditable coverage -- so the pre-existing condition exclusion period in your new plan can be no longer than 3 months. If you have more than a year of prior continuous creditable coverage, you won't have to worry about a pre-existing condition exclusion period in your new job-based plan at all.
Keep in mind that the prior creditable coverage must be continuous for it to count. For job-based plans, this means that you cannot have a gap in coverage of more than 63 days. If you have such a gap, you lose credit for everything prior to the gap and the clock starts running again from zero.
Each state makes its own rules for individual health insurance policies, so it is difficult to make a blanket statement about pre-existing condition exclusion periods under this type of coverage. As a general rule, though, it is to your advantage to remain continuously covered for as long as possible, because you may be able to use this prior continuous coverage to offset a pre-existing condition exclusion period. To find out more about health insurance laws in your state, please read the State Specific Information for your state. You can also visit Georgetown University's Health Policy Institute for a detailed Consumer Guide to your state's laws and regulations.
Sources:
Georgetown University Health Policy Institute. "Consumer Guides for Getting and Keeping Health Insurance." Accessed June 3, 2008.
