For far too long, consumers faced a highly problematic Catch-22 when it came to purchasing health insurance. Some consumers stayed healthy throughout the lifespan of a health insurance plan, which meant they never leaned on their policies for financial support. On the other hand, consumers who suffered from one or more health ailments could not buy a health insurance plan because insurers refused to insure those who lived with one or more pre-existing medical conditions.
A landmark federal law stopped the practice of denying health insurance coverage to consumers who lived with one or more pre-existing medical conditions.
Enacted in March 2010, the Affordable Care Act (ACA) is considered the most significant healthcare reform law ever passed by the United States Congress and signed by the President. The ACA is best known for opening the door to millions of uninsured Americans that previously could not afford to purchase a health insurance policy. What the ACA is not as well-known for is eliminating the requirement that to buy health insurance, you cannot receive a diagnosis for a pre-existing medical condition.
What is a Pre-Existing Medical Condition?
According to the results of a 2019 study released by the Kaiser Family Foundation, nearly 25 percent of all adults under the age of 65 live with a pre-existing medical condition. As defined by the Patient Advocate Foundation, a pre-existing medical condition is a health condition that a consumer has received a diagnosis for when trying to obtain health insurance. Some of the most common types of pre-existing medical conditions include cancer, asthma, diabetes, and epilepsy. Pregnancy also is another common type of pre-existing medical condition, but a few criteria apply to make a consumer eligible to receive health insurance coverage.
Before the passage of the ACA, health insurance companies either denied coverage or charged considerably more for consumers who lived with a pre-existing medical condition. The ACA has allowed millions of Americans living with a pre-existing medical condition to receive health insurance coverage.
Does Living with a Pre-Existing Medical Condition Mean I Have to Pay Higher Health Insurance Premiums?
If you live with a pre-existing medical condition, you might think there is a catch to becoming eligible to purchase a health insurance policy. The catch comes in the form of higher health insurance premiums. Why would a health insurance company offer you a policy if it loses money covering a sick policyholder?
Under the latest update to the ACA, insurance companies cannot charge higher premiums to consumers living with a pre-existing medical condition. If you purchase a health insurance policy through the ACA marketplace, you should not have to worry about buying a plan you cannot afford. However, you have to be aware of how some unethical insurance companies conceal charging higher health insurance prices for consumers who live with one or more pre-existing medical conditions.
One of the most common ways insurance companies disguise charging higher premiums for policyholders living with a pre-existing medical condition involves slapping an annual fee on a policy. Your insurance company might claim the annual fee covers costs such as administrative expenses, when in fact the annual fee is to provide a financial cushion that pays for your healthcare needs.
Am I Eligible for CHIP and Medicaid Coverage with a Pre-Existing Medical Condition?
It is not just a health insurance policy that is covered by the pre-existing medical condition provision of the ACA. The ACA also makes it possible for CHIP and Medicaid recipients to receive coverage while living with one or more pre-existing medical conditions. This means that if you qualify for either program, you have the right to receive coverage even if you live with a chronic health condition. Plans offered through the ACA-sponsored marketplace provide you with the most affordable insurance options for both CHIP and Medicaid policies.
The key factor that determines eligibility for both programs involves having an income that is below the federal poverty level.
What Factors Impact My Health Care Costs?
Before the enactment of the ACA, the cost of treating a pre-existing medical condition represented a prominent factor in determining the cost of a health insurance plan. With pre-existing medical conditions no longer a factor in determining the cost of a health insurance policy, what factors impact your healthcare costs?
One common factor that determines your health insurance policy cost concerns lifestyle choices. For example, if you use tobacco, you can expect to pay a higher premium for a health insurance policy. Another common factor is the size of your family. The more dependents covered under a health insurance plan, the higher your premium payments. Your location and the type of health insurance plan also play a role in determining the premiums paid for a health insurance policy.
Learn how to lower your health insurance premium.
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