You Have Been Declined for Health Insurance in California, Now What?

 If you are reading this then you probably have been declined for health insurance in the recent past. When you get declined for health insurance it probably has something to do with your medical history. Since California is one of the underwritten states healthcare companies have the right to decline people for health insurance. Which health insurance company might decline and who might not all depend on risk assessment using actuarial tables? Anytime when you fill out an individual application for health coverage and answer yes to one of the medical questions your application might be manually reviewed by one of the underwriters. It is a person who is responsible for reviewing applications using actuarial tables. Actuarial tables are statistics done by insurance companies, hospitals, doctors, and researchers that predict the cost of insuring someone with a specific medical history.

Some states like New York, New Jersey, and Washington require insurance companies to insure everyone. Those three states do not have medical underwriting and everyone is automatically approved for health coverage. In order to insure everyone with medical history insurance companies increase rates to the point where it becomes unaffordable to most people. What keeps the average monthly premiums low is the low utilization of health care. If there are more people with high medical insurance utilization with a specific health insurance company they have to raise the rates for everyone in order to keep up with paying medical claims. That also drives people who do not use health insurance that often to drop health insurance altogether and yet driving rates even higher. This leaves no choice for insurance carriers but to drive rates even higher. New York, New Jersey, and Washington have the highest premiums for medical coverage and a lot of families find health care out of reach.

In California, if you have been declined for health coverage you have options. If you are out of a job or currently on a low income you can qualify for Medical and if you have kids they can qualify for a program called Healthy Families. Most states including California have high-risk pools that are designed for people who have been declined individual health insurance.