Health Insurance Consumer Information

Kevin Lucia M.H.P., J.D., Assistant Research Professor at Georgetown University, has co-authored an article in the Winter 2006 issue of the Journal of Insurance Regulation (www.naic.org/store_jir.htm).

Imposition of Durational Residency Requirements by State High-Risk Pools: Constitutional Considerations
Kevin Lucia, M.H.P., J.D.; Susanne Addy, J.D.

Currently, 32 states maintain high-risk pools offering individual health insurance to residents that are otherwise medically uninsurable in the private health insurance market. In many of these states, applicants are required to have resided in the state for a specific period of time, called a “durational residency requirement,” before they can apply for coverage. After reviewing how many states impose a durational residency requirement on new applicants and why, this article discusses the constitutionality of these requirements in light of the 14th Amendment right to travel as interpreted by relevant U.S. Supreme Court rulings.

Periodically, our experts at healthinsuranceinfo.net receive questions from consumers who are looking for guidance in the health insurance market. This question came to us recently.

Question: I am a 27 year old with cancer. Can I buy individual health insurance?

Answer: It depends. Insurers in the market are likely to turn you down, unless the law requires them to sell you coverage. However, depending on where you live and other circumstances, laws may require insurers to offer you an individual policy. If that is the case, it will also be important to know whether other laws limit what you can be charged for health insurance and whether your existing medical conditions will be excluded from coverage.

In a few states individual market insurers are required to guarantee issue all products to all residents year round. In these states, an application with cancer must be issued an individual policy just like everyone else.

In a handful of other states, Blue Cross/Blue Shield or other insurers must offer guaranteed issue coverage to all residents.

In addition, you will also want to get information about COBRA, state continuation coverage, state high-risk pools, association health plans, public programs (such as Medicaid), and other possible sources of health coverage.

For more information about accessing individual health insurance coverage, see our Consumer Guides to Getting and Keeping Health Insurance, available at healthinsuranceinfo.net.

Georgetown University’s Health Policy Institute has released updated Consumer Guides for Florida and Iowa, as of January 2007.

Health insurance consumers, legislators, social workers and advocates use these guides for clear, comprehensive information on the rights that consumers have, and lack, as they enter the health insurance market in their state.

These guides are available in their entirety, for free, on this website in PDF format; see our copyright notice for reprinting and redistribution guidance.

• Florida Health Insurance Consumer Guide

• Iowa Health Insurance Consumer Guide