Hepatitis C and Choosing a Health Insurance Plan
Last updated: February 2022
A hepatitis C diagnosis may cause a fear that this record in a person’s medical history can cause them to be rejected from having access to healthcare in the future, due to a pre-existing condition. This fear is rooted in the very real experiences of millions of Americans for decades. However, one of the tenets of the Affordable Care Act is that no one can be denied health insurance coverage due to previous illness. This means that this concern, though once valid, is no longer cause for alarm.
Does HCV impact my insurance options?
Hepatitis C in and of itself does not alter which insurance choices are available to most people. However, some insurance companies (either private or through a person’s place of employment) may require a physical or other general check-up to ensure your general health as part of their enrollment process. For most insurance companies though, the only requirement is to complete basic identification documents and to choose the insurance plan they wish to purchase. These documents may ask for full names, social security numbers, and information about where a person lives and works, in order to make sure that the company is fully aware of who they are insuring. In other cases, especially if the insurance company or plan is specific to people of a certain age, race, gender identity, or income level, additional documents may be required to prove that the person qualifies. This may mean that insurance to cover a pregnant person must provide proof of pregnancy or that someone applying for low-income insurance such as Medicare or Medicaid will need to provide tax returns or bank records to show their need for government assistance. If you are uncertain whether your insurance company should be asking for personal documentation, you can contact them directly to inquire as to their need for the document and to find out how their company keeps your personal information private.
What if I currently live with the virus?
If you currently have hepatitis C, there is the possibility that your insurance enrollment process may be more complicated. Although part of the Affordable Care Act (also known as Obamacare) is intended to ban the refusal to cover pre-existing conditions, some insurance companies may require new paperwork, tests, and other documentation before they will begin to cover hepatitis C treatment or medication if you are switching from one insurance company to another or maybe even if you are simply switching between plans within the same company. This is intended to both verify previous insurance covered actions and to assess whether these healthcare providers are included on the new company’s insurance network or whether the new insurance company will recommend that you find a new facility and/or physician for your future hepatitis C treatment needs. This would include regular visits to your current physician, any anti-viral medication, any medications to treat side effects, and any visits with specialists to manage skin rashes, liver, or kidney problems, etc.
The goal is to minimize the stressors associated with insurance problems and to try to remove the risk of a pause in your treatment plan. To accomplish this, you may wish to contact the insurance company you are looking to switch to (or your current company if you are just planning to change plans) and discuss your concerns with them. They can help you to understand the transition process and they may be able to help you to make the transition as smooth as possible by providing blank documents or pre-authorization requests in advance so that there is little to no time in which your insurance is waiting to approve treatments or appointments with specialists.
What if I get hep C??
When choosing an insurance company for health insurance, many people are focused on the cost of their monthly payments (called “premiums”). In order to keep that price low, they may choose to sign up for an insurance plan with a very high out of pocket cost if a medical appointment or prescription is needed (called a “copay”). While this makes sense during a time when a person is healthy, it also means they are taking a risk. If a person takes that risk and becomes infected with hepatitis C during that insurance coverage period or if they are diagnosed with hepatitis C during that time, this may become an expensive choice to have made.
If this occurs, it is important to discuss your deductible with your treating physician. Together, you may be able to schedule numerous tests in one visit in order to only pay for one office visit fee, they may be able to prescribe you a generic version of a medication in order to maximize the insurance company’s portion of payment, or you may be able to be referred to a low-cost clinic where your needs can be met without emptying your wallet.