If I Have a Chronic Illness Will my Health Insurance Plan Change?

If you are diagnosed with a chronic illness and you’re already covered by insurance, your insurance plan should not change unless you decide that you could be better served by a plan with more comprehensive benefits. Changing your plan could change the way you pay for your health insurance and could increase the cost of your coverage. A diagnosis with a chronic illness could place you in a higher risk group, which may result in higher insurance costs.

Chronic Illness and Insurance Costs

Insurance companies determine the cost of health insurance by evaluating their members’ level of risk. If you have group coverage through an employer and you are rated as part of a large group, your rates may not increase if you develop a chronic illness. If you are diagnosed with diabetes, arthritis or another chronic condition, the risk you present is offset by members who have no serious health concerns.

If you have individual health insurance, your insurer will scrutinize your health condition more closely. Depending on the regulations in your state and your insurance company’s rating process, you may be classified in a higher risk group if you are diagnosed with an illness like Type 2 diabetes, cancer or heart disease. If you are diagnosed with a chronic illness, you will probably face higher health care costs because you’ll need more extensive treatment. You may decide to switch plans in order to receive more cost effective care.

For example, you may have had a high deductible health insurance plan with a low monthly premium before you were diagnosed with a chronic illness. At that time, you may have seen the doctor only for routine checkups, which were covered under your plan. You may have had no prescription medications, so you didn’t have to pay for drugs. Your out of pocket costs were low because your health care needs were minimal.

After being diagnosed with a chronic illness, you may require frequent appointments, diagnostic evaluations and medication. At this time, you may decide that a comprehensive managed care plan would be a more effective way to receive the treatment you need. Because the cost of your insurance will increase as your medical needs become more complicated, a plan with a higher premium, lower copayments and more extensive benefits may provide more affordable care.

Pre-Existing Chronic Illness

If you are covered by a group policy through your employer and you change jobs, your new employer’s insurance company will consider your chronic illness to be a pre-existing condition. Many insurance companies will cover pre-existing conditions under certain circumstances, especially if you work for a large company with large group coverage. However, you may be required to wait for several months before the insurer will cover your treatment for this condition.

Alternatively, your new insurer may give you the option to pay for a plan that will immediately cover treatment for arthritis, respiratory allergies, hypertension or another chronic condition. This plan will probably be more expensive than waiting for your benefits to begin under a more basic policy. Depending on the cost of the plan and the treatment you need, you might save money by paying for your medication or specialist treatments with your personal funds.

Because insurance plans vary from one company to another, chronic illness coverage may also vary. Even if you have no serious health concerns, it pays to review your insurer’s policies on chronic conditions. Evaluate your current plan to see how your health care needs might change if you were diagnosed with a chronic illness.