When it comes to health insurance, pre-existing conditions are a hot-button topic. Many people are confused about what a pre-existing condition is, whether it affects their ability to get health insurance, and how it impacts the cost of their coverage. In this blog, we’ll take a closer look at pre-existing conditions and health insurance, and separate fact from fiction.
What is a pre-existing condition?
A pre-existing condition is a health problem that you had before you applied for health insurance. Some common examples of pre-existing conditions include cancer, diabetes, heart disease, and asthma. In the past, health insurers could deny coverage to people with pre-existing conditions or charge them higher premiums. However, under the Affordable Care Act (ACA), insurers are no longer allowed to deny coverage or charge higher rates based on pre-existing conditions.
How does the ACA protect people with pre-existing conditions?
The ACA, also known as Obamacare, has several provisions that protect people with pre-existing conditions. These include:
Guaranteed issue: Insurance companies are required to offer coverage to everyone, regardless of their health status.
Community rating: Insurance companies are not allowed to charge people with pre-existing conditions more than those without pre-existing conditions. Everyone in a given geographic area is charged the same rate.
Essential health benefits: All health insurance plans sold on the individual and small group markets must cover a set of essential health benefits, including prescription drugs, hospitalization, and mental health services.
Pre-existing condition exclusions: Health insurance plans are not allowed to exclude coverage for pre-existing conditions.
What about short-term health insurance plans?
Short-term health insurance plans are not subject to the same regulations as ACA-compliant plans. As a result, they can deny coverage to people with pre-existing conditions or charge them higher rates. These plans also typically provide less comprehensive coverage and may have lower benefit caps. If you have a pre-existing condition, it’s generally not a good idea to rely on short-term health insurance as your primary source of coverage.
What should you do if you have a pre-existing condition?
If you have a pre-existing condition, the first thing you should do is shop around for health insurance plans. You can do this through your state’s health insurance exchange or through a licensed insurance broker. Be sure to read the plan’s summary of benefits and coverage carefully to understand what is and isn’t covered. If you have a specific medication or treatment that you need, make sure it’s covered by the plan you’re considering.
If you’re having trouble finding affordable coverage, you may be eligible for financial assistance through the ACA. Depending on your income, you may qualify for premium tax credits, cost-sharing reductions, or Medicaid.
Having a pre-existing condition doesn’t mean you can’t get health insurance. Under the ACA, insurance companies are not allowed to deny coverage or charge higher rates based on pre-existing conditions. If you have a pre-existing condition, it’s important to shop around for health insurance plans and understand what is and isn’t covered. If you’re having trouble finding affordable coverage, you may be eligible for financial assistance through the ACA.
Don't let a pre-existing condition stop you from getting the coverage you need. At Every Health Group, we believe that everyone deserves access to affordable healthcare, regardless of their health status. Visit our website at www.everyhealthgroup.com to get enrolled for $0 and take the first step towards better health today.