Private health insurance provides advanced access to medical coverage to individuals whose medical needs are not met by standard Medicare coverage, and under federal law insurers must provide coverage to all applicants regardless of age, physical condition and history of claims. This is known as guaranteed acceptance, and is designed to ensure that every citizen has the treatment options they require available to them.
However, there are factors that complicate the easy acquisition of effective insurance coverage by those most in need of it. Federal law also enables insurance providers to impose a two month waiting period before offering full policy benefits to any new applicant.
The policy was set in place to protect insurance companies from being flooded with more immediate claims than they can demand, which would result in higher premium rates for every client and perhaps the eventual collapse of the company in the wake of mass cancellations.
Insurers do have the discretion to waive this two month waiting period and give any new client access to full benefits, but are extremely unlikely to do so for someone who is very likely to make a claim soon after enrolling. While vulnerable applicants will still have some medical coverage during their probation period, it usually falls far short of what they require for their ongoing medical treatment.
Another obstacle to readily available health coverage is the PEA, or Pre-Existing Ailment. These are defined as any medical issue for which an individual has sought medical treatment within the last 5 years, and limitations on PEA coverage has an especially profound impact on the elderly and chronically ill.
Insurers can impose even longer waiting periods before providing coverage for expenses related to pre-existing ailments. Treatment benefit delays for pre-existing ailments can extend up to a full year from the date of policy inception, allowing ample time for the condition to worsen or complicate. This places the neediest clients in a difficult position, as the ailment which required insurance is often the one that cannot immediately be addressed with a new or upgraded insurance policy.
Despite the fact that private health providers cannot refuse to provide coverage for the elderly or chronically ill, the fact is that they can limit the services they provide to a wholly ineffective level for an extended period of time. Regardless, it is better to be waiting for treatment than to wonder if it will ever take place, and so applying for a policy in this situation is still a prudent idea.