Obamacare Pre-Existing Conditions FAQs

Ever since President Barack Obama, the 44th President of the United States, has been elected head of the nation on November 4, 2008, he has had numerous bills passed to make the lives of every American better. First, there was his administration’s economic policy, which involved increasing the taxes of the wealthiest people in America as well as investing in public services that helped boost the U.S.’ economy. These included a health care reform called the “Patient Protection and Affordable Care Act”, which was signed in 2010.

Also known as the Affordable Care Act or simply, Obamacare, this law was passed on March 23, 2010. Thanks to the efforts of the Democratic 111th Congress and the Obama administration, this bill was passed along with the Health Care and Education Reconciliation Act of 2010. This law’s main aim is to expand Medicaid eligibility for those who make up to 133% of the federal poverty level (FPL), to provide incentives for businesses to offer health care benefits to their employees, to subsidize insurance premiums for those who make up to 400% of the FPL, and to disallow insurers from putting annual coverage caps. Another important provision in the health care reform signed by President Obama was to prevent insurers from denying coverage and denying claims to people who have pre-existing conditions.

Before the Affordable Care Act was passed, Americans who have pre-existing conditions, medical conditions that a person may be suffering from before his or her health insurance took effect, whether diagnosed or not, and who did not receive any health coverage through their employers were left with very few options when it comes to health insurance. Some states even allowed insurance companies to deny coverage or claim, charge higher premiums or offer policies that did not include coverage for their health conditions.

As part of the act’s objective to provide affordable health care for all, the law created the Pre-Existing Condition Insurance Plan (PCIP), which was temporary. To be eligible for the program, you must meet the following criteria:

  • You are a U.S. citizen or reside in the U.S. legally.
  • You have not received health coverage within the last six months.
  • You have a pre-existing condition, or were unable to receive health coverage due to said health condition.

Today, the PCIP is run in 23 states and the District of Columbia by the U.S. Department of Health and Human Services, along with the U.S. Office of Personnel Management and the U.S. Department of Agriculture’s National Finance Center. To help administer benefits in all of those states, the United States Federal government contracts with a national insurance plan. For the rest of the 27 states, the program is run by the state or a nonprofit organization designated by the state.

However, only minimum essential coverage covers those with pre-existing conditions. During open enrollment, you can be covered in any major medical plan. You will need to enroll in minimum essential coverage during the annual open enrollment period from November 1, 2015 to January 31, 2016 for the year 2016. Keep in mind though that enrollment date could change every year and differ by insurance type. It is also the only time you can also switch plans and apply for cost assistance, unless you are able to qualify for a special enrollment.

Obamacare Pre-Existing Conditions FAQs

Q: Is there a limit on how high premium insurance companies can charge persons with pre-existing conditions?
A: Under the Obamacare, insurers are prohibited from charging consumers different rates for health coverage due to health status or gender. However, older people may be charged higher than young people. But the higher charge is capped at no more than three times the usual rate.

Q: Will there be a restriction on lifetime benefits in the event that the reform is repealed?
A: If you applied for a health plan that started after September 23, 2010, your insurer will not be able to impose limits on lifetime benefits. This is incredibly helpful for people with fatal diseases, such as cancer, or chronic conditions that require continuous and expensive treatment.

The likelihood of the Affordable Care Act being repealed is also far from happening. There have been numerous threats to abolish the law since it was passed on March 2010. In fact, the House of Representatives voted to repeal the law in 2011, but was rejected by the Senate.

Q: What if a person is fine now but has certain risks that cannot change; will he/she be denied coverage?
A: Before the Obamacare act, you could be denied coverage or charged a higher premium if you apply for insurance on the private marketplace. As a standard procedure, insurers will look into a person’s medical history, which could be a ground for them refuse to give him/her a health plan or make him/her pay more for it.

But with the ACA, which took effect in 2014, insurance companies will no longer be able to do all those things on the basis of a person’s health status.

Q: With the Obamacare, what can insurance companies deny?
A: Under the ACA, benefit plans offered through health exchanges will need to have certain essential services, such as inpatient and outpatient care, maternity and newborn care and wellness and prevention services, to name a few. However, insurers are allowed to design benefit plans beyond those requirements as long as they comply with state and federal laws. This is why it is important to be fully aware of the terms of your health plan and to follow everything stipulated in your policy to ensure that all health services you receive are paid for by the program.

Q: There were insurance companies that discontinued selling policies for juveniles with pre-existing conditions. Have they found a loophole in the law?
A: One of the provisions of the Obamacare act was to prohibit insurers from not selling health plans to children younger than 19 years old with pre-existing conditions. As a response to this mandate, many insurance companies dropped out of the child-only market altogether. Therefore, in this case, they have, in fact, found a loophole in the law.

There are a number of states, though, that have taken legal steps in keeping insurance firms in the child-only market. In California, for example, insurers who refuse to sell child-only health plans would be prohibited from selling any policies in the private market for five years. This forced the insurers into offering such health coverage effective January 1, 2011.

In order to understand how you and your family can benefit from the Affordable Care Act, it is important to know exactly what each provision says. In this case, it helps to know that although you have pre-existing conditions, you can still get cost assistance under the Obamacare program.

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