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Pre-Existing Conditions

Pre-Existing conditions refer to any health condition in effect prior to obtaining a health insurance policy. It is estimated that over 80 million U.S. citizens have some sort of pre-existing condition ranging from asthma to cancer. Prior to the Affordable Care Act these individuals had a tough time obtaining coverage, unless it was through an employer sponsored plan. Around 36% of such individuals were denied coverage, while others were charged much higher premiums based on their pre-existing health issue. Some carriers could even place exclusions on the policy, leaving the member without coverage for their condition. As a result, changes were desperately needed in the health care system to ensure those that needed coverage be able to obtain it.

Timeline for Pre-Existing Conditions Coverage:

Prior to 2010 – the only option for coverage was the Major Risk Medical Insurance Plan (or High Risk Pool) plan or a HIPAA plan (for those who exhausted their COBRA coverage). The only other option was to join an employer sponsored group health plan.

March 23, 2010 – The Affordable Care Act is enacted, and the Pre-Existing Condition Insurance Plan (PCIP) was added to the mix. Also, insurers are no longer allowed to deny coverage to anyone under the age of 19.

January 1, 2014 – all medical insurers must offer coverage to eligible enrollees regardless of their pre-existing conditions. Even grandfathered plans (those issued prior to March 23, 2010) must remove any pre-existing condition exclusions by this date.

Though people are concerned about premiums rising based on the increasing number of “sick” people in the exchange, the theory is to also increase the number of “healthy” enrollees to keep things in check. By spreading the risk across the board, insurers will be able to cover those with pre-existing conditions as well as those without. This makes the term a lot less scary for insurers and enrollees alike.

Let our Health Exchange Quote agents answer any questions you have about getting coverage with a pre-existing condition.

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