Pre-existing condition health insurance coverage is easier than ever to purchase. Individuals, families, and small business owners with current health conditions, can buy policies, either through Open Enrollment, or with any other “guarantee issue” plan. You can no longer be denied coverage or designated treatment, and can not be charged a higher rate because of medical conditions or lack of prior coverage (Exchange plans). There is also no longer a requirement to have previous coverage to qualify for a private medical plan.
Past treatment or future scheduled treatment or surgery, does not impact how much you pay for coverage, and “essential health benefits” must be covered. Also, once you have enrolled in a qualified policy, future treatment can not be rejected, unless specifically excluded in the policy and approved by the HHS. Maximum annual and lifetime benefits are also not capped. This includes prescription drugs, surgeries, office visits, and major medical expenses. Instant tax credits can reduce premiums for qualified applicants.
Rates, of course, can vary by a wide margin, depending on where you live, how much money your household earns, and of course, your age. Benefits will not be the same in all areas of the country. That’s why our professional shopping help can save you money. We find and compare the best policy options for you and any other family member. Your budget and projected medical expenses help determine our recommendations.
Non-Obamacare plans should be considered in many situations, when a Marketplace option is not offered. This includes time periods when Open Enrollment has closed or an on-Exchange plan is too expensive to afford because a subsidy is not available. Temporary short-term plans are available in most states and provide a low-cost healthcare option. However, pre-existing conditions are not covered, and lifetime expense maximums are typically $250,000-$2 million.
It Started Eight Years Ago
Beginning in 2014, pre-existing and chronic conditions had no impact on the price you pay. Although your smoking status, age, and where you live will determine your premium, only the type of plan you choose has a major effect on pricing. Thus, whether you have impeccable health, or are a walking hospital ward, it will not have any impact on the cost of your medical plan. Financial subsidies (if you qualify) can substantially reduce the cost of coverage and lower copays, deductibles, and out-of-pocket expenses on Silver-Tier plans (cost-sharing).
We find the carriers that offer this type of coverage and make it easy for you to compare your options. Easily, you can apply for private coverage here. Simply provide your zip code in the box at the top of this page and soon you’ll be presented with the best choices from reputable companies, including Blue Cross, Aetna, UnitedHealthcare, Humana, Cigna, and other regional carriers. However, in many states, major companies (Aetna, Humana, and UnitedHealthcare) no longer offer “On-Exchange” plans although they may return in 2022.
What Is A Pre-Existing Condition?
A pre-existing condition is a mental or physical health injury or illness that is present before you apply for a health insurance plan. It also may be a condition that someone has received treatment, consultation, or medical advice. Also, if symptoms were present, they may be considered a pre-existing condition if treatment should have been performed, but was not. If you are not aware of a sickness, then typically, it’s not considered. If you were advised of a condition, and refused treatment, it will not be covered under a non-Exchange plan.
Pre-existing conditions, as earlier mentioned, will not impact your cost. For example, high blood pressure, anxiety, high cholesterol, asthma, allergies, depression and acid reflux will not cause a denial for coverage or an increase in your premium. If coupled with other conditions, a denial for medical coverage is still not going to occur, thanks to changes in our nation’s laws (Obamacare).
And if coupled with a high BMI (Body Mass Index), a denial still will not happen. In the past, each insurer was able to interpret the BMI numbers in different ways. Sometimes, one company would offer a policy while another would reject the same application. But now, you will not find any questions about your height or weight on standard applications. However, if you miss Open Enrollment or don’t qualify for a special Open Enrollment exception, the plans you apply for may require underwriting. Although a physical will not be required, a report of your medical history may be reviewed.
Limited Time Period Policies
A limited time-period policy (also called “short-term” or “temporary”) covers you for a year (or less) and is an underwritten contract. Therefore, you do have to qualify and be approved for the policy to be in effect. Although there are only a handful of health-related questions (perhaps 2-4), by providing a “yes” answer, it’s likely your application will be denied. Several companies also consider your BMI and other non-medical factors, such as hazardous sports, hobbies, and avocations.
Policy coverage up to 36 months is offered in selected states. Eleven states also do not allow the purchase of temporary plans. If Medicare expands to lower ages, it is likely that short-term plan availability will be reduced in many states. Expansion of Open Enrollment periods can also impact availability.
If an applicant for a short-term plan takes medications for high blood pressure and high cholesterol, and also is obese, they will be denied coverage. Also, typically, most forms of cancer (not necessarily skin cancer), diabetes, pregnancy and heart disease will cause an application to be rejected. Rheumatoid arthritis, epilepsy and muscular dystrophy will all likely cause a denial in coverage. However, if these conditions were once present and now no longer exist, the underwriters may view this favorably.
Depending on the carrier and the state, the medical questions may only “look back” five years. In those situations, pre-existing conditions may no longer be relevant, and will have no bearing on the underwriting. It is VERY important to note that any Exchange or Marketplace application (during Open or a Special Enrollment) never asks medical questions. Legal residential status is required and applicants will be denied if they ae currently incarcerated.
So although a temporary option is cheap, and can get quickly issued, it is not designed to be a long-term replacement for permanent plans, such as an Exchange contract or a group policy your employer provides to their employees. However, if you will become Medicare-eligible within six months, and no other guarantee-coverage options are available, a short-term plan may be an appropriate fit.
How To Qualify For Health Insurance
Most applicants qualify for coverage with pre-existing conditions. So the need for special state programs has greatly diminished. Previously, for persons that did not qualify, each state had a “Risk Pool” that was established through the “Patient Protection And Affordable Care Act.” A special plan (PCIP) was offered to persons that had been uninsured for at least six months. Comprehensive benefits were offered although out-of-pocket costs were sometimes high and preventative benefits were not always 100% covered. Maximum out-of-pocket expenses varied, depending upon the state and type of plan.
Every state offered this coverage. Pennsylvania’s rates, for example, were very inexpensive (about $250-$300 per month). However, each state charged different rates. Smoker prices were typically higher than non-smoker prices. It is unlikely we will see these types of policies offered again, unless the Affordable Care Act legislation is repealed. Although the expansion of Medicaid has been approved in many states, the concept of “Medicare For All” does not have nationwide support.
How Did The PCIP Work?
The PCIP was created to help individuals that had trouble obtaining health insurance coverage. The PCIP plan provided comprehensive medical coverage and did not charge a higher rate because of pre-existing conditions. To qualify for coverage, some of the requirements were:
1. Uninsured for the last six months.
2. Had difficulty buying health insurance.
3. Citizen of the United States or living legally here in the US.
4. Show a copy of a letter from an insurance company within the last six months denying your application or excluding your medical condition.
What is HIPAA?
The Health Insurance Portability And Accountability Act (HIPAA) was enacted by Congress in 1996. It was designed to provide protection for persons that are purchasing, altering or continuing their health insurance coverage. Entities that must follow regulations are insurance companies, HMOs, Medicare, Medicaid, doctors, dentists, hospitals, medical facilities, health care clearinghouses, companies that administer health plans, and companies that destroy or retrieve documents. Some of the important articles of the Act include:
- Guarantee renewal of your health insurance regardless of individual or family health conditions.
- Pre-existing condition exclusions are limited.
- Prevents many medical insurance plans from denying coverage or raising premiums due to health problems.
HIPAA also considers “credible coverage” when determining pre-existing condition exclusions. Credible coverage is defined as benefits that were in effect without more than a 63-day break in coverage. This coverage can be used to preclude pre-existing condition exclusion periods that may be contained in a new health insurance policy. “Limited Benefit” plans are generally not considered as credible coverage, since they typically have large gaps in benefits. Short-term and “mini-med” contracts are treated the same way.
View Free Quotes Now
We built this website so you could quickly apply online for quality pre-existing medical insurance coverage from the top companies. We understand the application process can be quite tedious and time-consuming. That’s where we can help. Simply provide your zip code at the top of the page to begin the free quote process. There is no obligation at any time.
Previous Supreme Court rulings upheld The Affordable Care Act, making qualifying for a policy much easier. Children under the age of 19 now have more options also. Quite simply, all persons (assuming they are US citizens and meet a few simple requirements), will not have to worry about what medical issues they have or had in the past. As previously mentioned, annual Open Enrollments allow for the easy purchase of coverage on an ongoing basis.
Updates From The Past
Open Enrollment has arrived (actually on October 1st) and policies issued in 2014 will require that no medical questions be asked and you can not be denied. Also, the federal subsidy will pay up to 100% of premiums (if you qualify) and drastically reduce rates for millions of Americans.
State Marketplaces open in November, and we will continue to offer the lowest available rates through our free quotes. Individuals and families with current coverage will be able to keep “grandfathered” plans. You will receive notification from your current company regarding the status of your policy.
The first year of Open Enrollment is behind us, as we prepare for the second year. November 15th is the first day for 2015 effective dates. Rates are being filed over the next few months, and State Departments of Insurance are reviewing the proposed prices and will make their rulings known this month and next month.
Several new companies are expected to participate in Exchanges and the availability of doctors and specialists should increase in many areas. The functionality process of purchasing a plan should also be much better. You can review policy prices and coverage in advance through our website. Financial subsidies will continue to help lower your cost.
Although pre-existing conditions are still covered on Marketplace plans, availability of plans has become a major issue in many states. In many areas, only one carrier offers coverage, and often prices have dramatically increased within the last two years. Treatment of serious medical conditions can also be challenging, since provider networks have become smaller.