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Old 04-07-2010, 11:17 AM   #1
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Join Date: Apr 2010
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23kiddo HB User
Pre-existing condition waived under new Health Care Reform (News + Experiences)

I'm new here and have been doing a considerable amount of research on Maternal Health Coverage, as I am also new to the US.

We have never had health coverage in the US. My wife is a US citizen though. Initially when I called a few insurance companies, I was surprised to find out that insurance companies will not take on pregnant women, as they are too high risk. So, when the Health Care Reform Bill was passed into law, you could only imagine how excited I was.

The grey area since the bill passing on March 21, has been the developing story of the pre-existing condition waiver, and the high-risk pool.

This, according to many articles i've read recently is supposed to be in effect 90 days after the bill was passed. I spoke with Blue Cross, and they confirmed that they could not offer us any coverage now, but in the coming months (specifically after June 21) us not having insurance now in the US for more than 6 months and my wife's pre-existing pregnancy condition would potentially qualify us to be put into the new High-Risk Pool, that would get us maternity insurance under the new Health Care Reform law. This could not be confirmed though, as many of the details are yet to be ironed out.

What I am looking to do with this post, is get people's insight (read: not political stance) on their experiences or any breaking news on this topic, to help pregnant mothers in similar situations as ours, get maternal coverage with a pre-existing pregnancy condition.

Last edited by 23kiddo; 04-07-2010 at 12:18 PM.

 
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Old 04-08-2010, 05:15 AM   #2
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kewlgirl HB User
Re: Pre-existing condition waived under new Health Care Reform (News + Experiences)

Most pregnant women that don't currently have health insurance coverage can quality for Medicaid.

Medicaid is insurance that is paid for by the government. To qualify, you have to meet certain criteria, such as being low income or being pregnant. It is very difficult for a pregnant woman to be denied if she doesn't already have insurance.

Here is some information on Medicaid.

Good health is important to everyone. If you can't afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy – and stay healthy.

Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.

Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. Read more about your state Medicaid program.

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.

Your child may be eligible for coverage if he or she is a U.S. citizen or a lawfully admitted immigrant, even if you are not (however, there is a 5-year limit that applies to lawful permanent residents). Eligibility for children is based on the child's status, not the parent's. Also, if someone else's child lives with you, the child may be eligible even if you are not because your income and resources will not count for the child.

In general, you should apply for Medicaid if your income is low and you match one of the descriptions of the Eligibility Groups. (Even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation.)

Screening Tools

To help you see if you may be eligible for a variety of governmental programs, you may access the GovBenefits and BenefitsCheckUp websites.

When Eligibility Starts

Coverage may start retroactive to any or all of the 3 months prior to application, if the individual would have been eligible during the retroactive period. Coverage generally stops at the end of the month in which a person's circumstances change. Most States have additional "State-only" programs to provide medical assistance for specified poor persons who do not qualify for the Medicaid program. No Federal funds are provided for State-only programs.

What is Not Covered

Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups. Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the TANF program or from the SSI program. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.
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Old 04-09-2010, 06:43 AM   #3
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Join Date: Apr 2010
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23kiddo HB User
Re: Pre-existing condition waived under new Health Care Reform (News + Experiences)

Medicaid is an option for some, but for people that are working or have an average amount of income, there isn't (wasn't I should say) an option for maternal coverage.

Shame you can't post links here, but there are stories circulating on the internet, and hopefully some progress is made with this law and the waiving of the pre-exisiting condtion for pregnancy by the stated deadline of June 21, 2010. Here is an excerpt from a story PBS ran:

"In one of the first moves the Obama administration has taken under the new health care reform law, Health and Human Services Secretary Kathleen Sebelius on Friday sent a letter to state governors and insurance commissioners intended to gauge interest in a new insurance high-risk pool program. The health care reform bill provides $5 billion in funding to create a network of insurance pools for people with pre-existing medical conditions who do not have insurance. The pools are intended to open within 90 days, and are a stopgap measure that will last until 2014, when insurance companies will no longer be able to deny coverage to anyone based on pre-existing conditions"

 
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