Living Donors Online Message Board
Living Donation Discussion and News => Living Donation Forum => Topic started by: Clark on September 30, 2013, 11:15:57 AM
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https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/
Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition.
Being sick doesn't keep you from getting coverage
Starting in 2014, being sick won't keep you from getting health coverage. An insurance company can't turn you down or charge you more because of your condition.
Once you have insurance, the plan can't refuse to cover treatment for pre-existing conditions. Coverage for your pre-existing conditions begins immediately.
This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.
One exception: Grandfathered individual health insurance plans
The only exception is for grandfathered individual health insurance plans--the kind you buy yourself, not through an employer. They do not have to cover pre-existing conditions.
If you have one of these plans you can switch to a Marketplace plan during open enrollment and immediately get coverage for your pre-existing conditions.
Be sure not to miss open enrollment
You can apply for Health Insurance Marketplace insurance when open enrollment starts on October 1, 2013. Coverage starts as soon as January 1, 2014.
Open enrollment ends on March 31, 2014. Outside of open enrollment, you can't enroll in Marketplace coverage unless you have a qualifying life event.
Open enrollment will begin again in October 2014.
Find out what you can do now to get ready to enroll.
Pre-existing conditions with Medicaid and CHIP
Medicaid and the Children's Health Insurance Program(CHIP) also can't refuse to cover you or charge you more because of a health condition.
Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)
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The state health insurance marketplaces are open as of today. If you're looking for health insurance for 2014, visit http://www.healthcare.gov
On this site you'll be able to read through educational material as well as set up an account for purchasing coverage through the federally-facilitated marketplaces (state marketplaces operated by the federal government). A handful of states are operating their own marketplaces, and you can follow links to those sites.
As John's note mentions, coverage purchased through the marketplaces have to meet certain minimum requirements, including elimination of pre-existing condition exclusions. That can matter to living donors, who have found some insurance companies denying them coverage because of their donation. You might also qualify for premium subsidies depending on your household income.
Let us know if you have questions about this new world of health insurance and we'll do our best to get you answers.
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We'll see. All that glitters is not gold. It's one thing to have no pre-existing conditions to exclude you. But what about the price? That might exclude you. So I'm trying to be optimistic but this is the government after all.
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The pre-existing condition part of the ACA applies both to eligibility and premium price calculation: perhaps the largest part of the reform is that people who either couldn't get insurance at any price, or only at a price too high to afford, will now have an opportunity to get affordable insurance. This is the reason for the universal requirement, if only the people requiring more treatment expense than the premium they pay are insured, the insurance companies will go broke. They now have to set their premiums so that they're not scaled by pre-existing condition. I understand your concern, but this compromise has never glittered for anyone. With any luck, it's not so impaired that it will work even half as well as Massachusetts' and Hawaii's programs have. The other residents of the other 48 states deserve no less.