When you look at health insurance, you may come across terms like hospital and outpatient coverage and not fully understand what they entail. As attention once again focuses on the possibility that the Affordable Care Act (ACA) could be repealed, millions of people with pre-existing conditions have reason to worry. Among many other provisions, the ACA prohibited discrimination against private health insurance based on health status – insurers are prohibited from refusing individuals, charging them more, or changing their coverage to exclude their pre-existing conditions. Your health insurance may not cover the chronic conditions you have. Chronic diseases are conditions that: If you opt for full medical underwriting, it means that your medical history will be taken into account in deciding which conditions we may or may not be able to cover. We generally do not cover you (or your family members of your policy) for conditions that existed prior to taking out insurance with us. The existing coverage rule does not apply to grandfathered individual health insurance plans. Grandfathered individual health insurance is a policy that you purchased for yourself or your family on or before March 23, 2010 and that has not been changed in a particular way that reduces benefits or increases costs for consumers. What are pre-existing conditions and who has them? As most simply defined, a pre-existing condition is any health condition a person has before enrolling in health insurance. A pre-existing condition could be known to the person – for example, if they know they are already pregnant.
People can also apply for coverage if they unknowingly have an undiagnosed disease — for example, tumor cells might grow there, but aren`t diagnosed until months or years later. A pre-existing condition may be mild – for example, seasonal allergies or acne, which are treated with simple medications. Or it could be more serious or require more expensive treatment — such as diabetes, heart disease or cancer. Under current law, health insurance companies cannot refuse to insure or bill you more simply because you have a “pre-existing condition,” which is a medical condition you had before the start date of the new health insurance. Before purchasing health insurance, it is important that you fully understand what is covered and what is not. It usually depends on the type of coverage you buy, but there are some things that aren`t usually covered in most policies, regardless of which provider you choose. With the moratorium, you are not insured for pre-existing conditions until two years have passed without incident for each condition. These conditions are not covered because health insurance is used to treat acute medical conditions, where you can be treated in a private health facility to restore your health as it was before. However, they can sometimes claim unexpected outbreaks of chronic diseases.
Health insurers can no longer bill you or your child or deny coverage because of a pre-existing medical condition, such as asthma, diabetes or cancer. You also can`t limit the benefits for this condition. Once you have insurance, they cannot refuse to cover the treatment of your pre-existing condition. KFF estimates that in 2018, about 54 million non-seniors in the U.S. (27%) had “decreasing” pre-existing conditions that would have made them “uninsurable” in the individual health insurance market before the ACA. The conditions that can be declined were identified by an analysis of the underwriting manuals of health insurance companies. Insurers maintained lists of conditions for which claimants were routinely denied coverage. Conditions that could be declined included AIDS/HIV, congestive heart failure, diabetes, epilepsy, severe obesity, pregnancy, and severe mental disorders.
Obviously, not all of these 54 million adults have individual health insurance. But the individual market is where people go when they are between jobs that offer health benefits and are not eligible for coverage under public plans like Medicare or Medicaid. If it were to revert to medically guaranteed coverage — as was the case in most states before the ACA — these 54 million adults might not be insurable if they were laid off and lost their employment-based health services. Health insurance usually does not cover pre-existing conditions. Pre-existing conditions and related medical conditions are often excluded from your policy because health insurance is designed to handle new conditions that arise after your coverage begins. The only exception to the already existing coverage rule is the acquired rights of individual health insurance – the type you buy yourself, not through an employer.