Moving from a Medicaid Plan to an Individual Health Plan

I am losing Medicaid coverage, and I need individual coverage because I am not eligible for coverage through an employer-sponsored plan:

Can a plan refuse to enroll me just because I am sick?

Maybe. It depends on where you live. Federal HIPAA protections for people seeking individual coverage apply only to people who were most recently covered through an employer-sponsored health plan. Nevertheless, some states do have special provisions that give former Medicaid beneficiaries the right to individual coverage. Contact your state insurance department for more information. You can find contact information at http://www.naic.org/state_web_map.htm.

Can a plan charge me more based on my health?

Yes, but . . . The federal government does not regulate insurance premiums in the individual market. On the other hand, some states do not allow insurers to charge higher premiums based on health status. Contact your state insurance department for more information. You can find contact information at http://www.naic.org/state_web_map.htm.

Can a plan refuse to cover my illness for a period of time just because my illness was preexisting?

Yes, but . . . Although Medicaid is considered creditable coverage, there are no federal restrictions on how long an insurer may refuse to cover you under an individual health plan. However, some states do place restrictions on insurers. Contact your state insurance department for more information. You can find contact information at http://www.naic.org/state_web_map.htm. 

[Return to chart]