For residents who find themselves medically uninsurable on the individual market due to a preexisting condition, the insurer of last resort in many states is the “HIPAA plan.” In some states, every insurance carrier operating in the state must have a HIPAA plan option available. In other states, this responsibility is given to one specific carrier, for example Blue Cross and Blue Shield in Delaware. The HIPAA plan is offered in lieu of a state high risk pool option to residents considered “HIPAA eligible”: those who have had 18 or more months of prior creditable coverage which ended not more than 63 days ago and/or had no break of more than 63 days, were most recently covered under a group plan, have no other health coverage in force, and are not eligible for Medicare/Medicaid/group insurance/COBRA continuation plan. If HIPAA eligible, one cannot be denied for the HIPAA plan. If you have had 18 months of prior creditable coverage, the carrier will not impose a waiting period for preexisting conditions. You may or may not need to have been denied from another individual plan in order to enroll in the HIPAA plan.
The states which offer one or multiple HIPAA plan options in lieu of a high risk pool are listed here along with the state’s Department of Insurance information. Also below are links for more information on health insurance in each of these states. If you live in one of these states and think you might be eligible for a HIPAA plan, call your state’s Department of Insurance.