Pre-Existing Health Conditions
The Affordable Care Act requires insurance companies to cover people with pre-existing health conditions. It doesn’t matter if you have been turned down or refused coverage in the past. Coverage for pre-existing conditions will be effective for all health plans beginning on or after January 1, 2014.
The new law ensures:
- Insurance companies can’t deny coverage or charge more for people with preexisting conditions.
- Insurance companies can no longer deny you for any reason other than fraud.
- Insurance companies can’t put lifetime or annual dollar limits on Essential Health Benefits such as screenings, preventions, and treatments for most life threatening sickness.
- Plans cover free wellness and preventive services.
- Subsidies are available for those who make less than 400% of the Federal Poverty Level.
The benefits, rights, and protections offered to those with preexisting conditions only apply to plans that have to comply with The Affordable Care Act (ACA).
*If your plan was issued before 2014 and would have faced cancellation in 2014 but the “fix” to keep your plan until 2015 was put in place, it may be exempt from any or all of the above.
The Guaranteed Issue
- The ACA guarantees that health plans must let you enroll regardless of health status, age, gender, or other factors that might predict the use of health services.
- Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll.
The Guarantee Renewal
- The ACA requires health insurance issuers to offer to renew or continue coverage at the option of the policyholder as long as they continue to pay premiums.
- Except in some states, guaranteed renewal doesn’t limit how much you can be charged if you renew your coverage.
- The only exception is for grandfathered individual health insurance plans. These plans do not have to cover pre-existing conditions.
- If you are covered by a plan that existed March 23, 2010, your plan may be “grandfathered.” If you have a grandfathered plan, you can switch to a Marketplace plan and immediately get coverage for your pre-existing conditions.
- To find out if your plan is grandfathered check your plan’s materials and/or check with your employer or your health plan’s benefits administrator.
Medicaid and CHIP
- Medicaid and the Children’s Health Insurance Program (CHIP) cannot refuse to cover you or charge you more because of a health condition.
- Smoking is not a pre-existing health condition under The Affordable Care Act. Insurers can charge more in premiums for smoking status. This is called a “tobacco surcharge.”
- Smokers can be charged up to 50% more for their premiums.
- The tobacco premium surcharge is calculated after cost assistance.
- The surcharge won’t go into effect until 2015.
- The surcharge does not apply to all states.
- The Affordable Care Act offers new benefits, rights, and protections for people who have cancer or are at risk.
- If you have any questions, call 1-800-821-0604 , (219) 736 7800