You may assume that since you have a pre-existing condition, you’ll pay a higher premium than someone who is in perfect health. However, an insurer cannot reject you, refuse to pay for health benefits pertaining to your illness or injury, or charge you a higher premium because of your condition. Once you’re enrolled in the health insurance plan, the insurer can’t deny you coverage or raise your rates based only on your health. Smoking rates can be higher than non-smoking rates, however.
Related article: How are Health Insurance Premium Rates Determined?
Purchasing an Health Insurance with a Serious Pre-Existing Condition
Prior to 2014, purchasing individual healthcare with a pre-existing condition, an insurer might have declined covering your condition, or they might have denied you coverage altogether. However, now with the ACA, insurers must provide individual health insurance (with the “10 essential health benefits”) that can no longer exclude, limit, or deny coverage solely because of a pre-existing condition.
Here are the 10 essential health care benefits:
♦ Ambulatory patient services (outpatient)
♦ Emergency Room
♦ Maternity and newborn care
♦ Mental health and substance abuse
♦ Rehab and habilitative services
♦ Wellness and preventative services
♦ Pediatric dental and vision
When Can I Enroll For Health Insurance?
The ACA (Affordable Care Act) eliminated the restrictions on coverage for pre-existing conditions, meaning that those who have a pre-existing injury or illness no longer have to go through a waiting period for their pre-existing conditions to be covered. For this reason, coverage can generally only be purchased during the “Open Enrollment Period” which is November 1st through December 15th each year. There is a handful of qualifying life events, such as a change in residence from one state to another, or birth or adoption of a child, etc., that can trigger a “special enrollment period” and allow you to enroll/make changes without having to wait for your plan to start. Nevada is also blessed that we can continue to enroll into health insurance year-round, even without a “Life Event”. But, if you don’t have a “life event” or it’s not “open enrollment”, you can expect to have a minimum 90 day waiting period.
The cost of healthcare is at an all-time high. As someone with a serious condition, you want to make sure that you can afford medical care. A robust health insurance plan is your key to making sure that you can pay for appointments with specialists, therapy, prescriptions, and anything else that goes with managing or recovering from your condition.
Get Help Choosing Your Health Insurance Plan?
If getting health insurance through your employer isn’t an option, then you’ll need to purchase an individual health insurance plan. Individual health insurance is coverage that an individual purchases for themselves and their family. The Affordable Care Act (ACA) outlines the benefits that these policies must provide, and the state where the policy is purchased regulates its provisions.
Individual health insurance is a complex maze with a variety of coverage offerings and premium costs, so it’s generally purchased with the advice of a professional health insurance agent.
Professional help will not add cost to your premium.
Having a licensed Nevada Health Insurance Agent help you find a health insurance plan is particularly important if you have a serious pre-existing condition. They will guide you and advise you so you are not mislead into getting a health plan that has insufficient coverage. Even if you are healthy, with the new 2019 laws, and no more “individual mandate” (the provision of the Affordable Care Act that makes you have insurance or pay a penalty that is going away), you’ll want to speak with an experienced and educated/knowledgeable health insurance agent that can discuss your options. These options could result in saving you thousands of dollars in medical costs or premiums you don’t need to pay.
Important To Read: Why Use a Health Insurance Agent?
We’re here to help you navigate the ins and outs of individual health insurance to make sure you get the plan that will provide the coverage you need to manage your pre-existing condition, or your healthy economically conscientious needs. Give us a call today to talk about your options.