Risk of getting cancer: 90%, chance of getting insurance?

My wife has a history of cancer in her family and a doctor told her she has a 90% chance of getting it.  She is 32 and we live in New Jersey.   My question is can she be turned down for insurance?

Worried in the Garden State

Dear Worried in the Garden State,

First the good news – no, she cannot be turned down.

Now, the details:

I am assuming that your wife is looking for an individual health insurance plan, one that is not offered through an employer.  (An employer’s group plan cannot turn her away, in any case.)  If your wife has lived in New Jersey for at least 6 months, does not have a group plan offered to her, and does not qualify for Medicare, then she cannot be turned down for individual health insurance.  In fact, the carrier cannot base what they charge her on her health history or a family member’s health history.

You might find the New Jersey Individual Health Coverage Program Buyer’s Guide very helpful.  See the section titled “Guaranteed Coverage and Guaranteed Renewability” for the specifics.

The Affordable Care Act (“health reform”) requires insurers to offer individual health insurance the same way that New Jersey already offers it: the insurer takes all comers and rates are not based upon health status.  For many states, this will be a big change.  For others, like New Jersey and Maine, it’s business as usual.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.