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Ending insurance/Lapse in coverage
Aug 17, 2007


I recently moved to Massachusetts. My insurance coverage from school in California will end midnight on Thursday, August 16. I was diagnosed with HIV while under my school's insurance plan.

I believe I might be eligible for a no-cost health insurance plan provided by Massachustts state but the application process takes about three to four weeks. As a result, I will be without health insurance for up to a month.

My question is this: is there any concern about being without coverage for those few weeks in terms of future premiums/costs/acceptance into health insurace for having a pre-existing condition or whatever it's called? I've looked into getting short term private health insurance for the period when my application is pending but it looks to be quite expensive. If that doesn't work out, should I be concerned about not having insurance for up to a month - in terms of future premiums, insurance costs, and being accepted by insurance companies? Are there any other concerns to be worried about (besides the obvious risk of being uninsured)?

Thanks for your help.

Response from Ms. Franzoi

With a pre-existing condition, it can be risky to be without coverage. What if you don't qualify for the no cost plan in Massachusetts? What will you do? Will you look for a job with health benefits? Or will you try to purchase an individual health policy? You should think about this.

However, there are some safeguards in the law(HIPAA) that provide protection. Under HIPAA, a plan cannot have a pre-existing condition clause that lasts for longer than 12 months (unless you are a late enrollee) and the plan must recognize prior periods of coverage (called Creditable Coverage) towards that pre-existing condition exclusion period as long as you didn't have a break in coverage of 63 days. The important thing is not to have a break in coverage that is 63 days or more. If you don't qualify for the no cost plan and you don't have the opportunity for coverage under a group plan with an employer, you could apply for a HIPAA policy. A HIPPA policy would be available to you as long as you don't have a break in coverage of 63 days or more. However, HIPAA policies are typically more expensive with lesser benefits thaan a policy issued at standard rates.

LTD Process of Approval/Disapproval
LTD (Independent Medical Evaluation) and SSD Benefits

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