Shopping for Health Insurance with a Pre-Existing Condition

Pre-existing conditions used to be a significant obstacle to acquiring health insurance before the Affordable Care Act was passed, requiring that those with medical conditions jump through hoops to get necessary medical care and prescription drug coverage. Oftentimes, those with pre-existing conditions either couldn’t get health insurance at all, couldn’t get coverage for any care related to their medical conditions, or had to have a loved one provide coverage through their employer’s health insurance coverage.

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Before the ACA (Obamacare), there was medical underwriting. This meant, those with pre-existing medical conditions like high blood pressure most likely would get approved at a slightly higher rate. However, if they had high blood pressure, diabetes, and gout, they most likely would be denied coverage. If they did get approved, their pre-existing health conditions wouldn’t be covered for a certain period.

Are Pre-existing Conditions Covered Under My Insurance?

While it’s now much easier to obtain health insurance coverage for pre-existing conditions, not every health insurance plan provides coverage for those with previously diagnosed medical conditions. If you have a pre-existing condition, it’s important to ensure that the health insurance plan you choose provides coverage for your condition. ANY medical plan that is ACA (Obamacare), is a “Qualified Health Plan”, group coverage through an employer, or Government plan like Medicaid/Medicare/VA will cover pre-existing conditions.

On Exchange Marketplace Plans and Pre-Existing Conditions

On exchange marketplace health insurance plans AND “Off Exchange ACA” plans are required to provide coverage for 10 essential health benefits.

These benefits include:

♦ Ambulatory patient services

♦ Emergency services

♦ Hospitalization, including surgery and overnight stays

Maternity care, including prenatal and postnatal care

Mental health and substance use disorder services

Prescription drugs

♦ Rehabilitative and habilitative services and devices

♦ Laboratory services

Preventative care and wellness services, including chronic disease management

♦ Pediatric care

In addition to these 10 essential health benefits, on exchange Marketplace health insurance plans must also provide birth control coverage and breastfeeding coverage.

These benefits are the minimum requirements for all on exchange Marketplace plans. The exact services covered by different plans may vary from one state to another. Some plans may have additional benefits, such as vision and dental coverage and medical management programs for specific needs like diabetes or weight management.

In most cases, if you have a pre-existing condition and you’re looking for health insurance, “qualified health insurance plans” (ACA or Obamacare) both on and off exchange are the best option for you. All on exchange Marketplace health insurance plans are required to provide coverage for pre-existing medical conditions, meaning that no insurance plan can reject you or refuse to pay for the 10 essential health benefits. In addition to this, once you’ve enrolled in a plan, your rates can’t go up solely based on your health. The only way your rate may be higher than someone else is for tobacco use.

Off Exchange Health Insurance Plans

Unlike on exchange Marketplace plans, off-exchange plans do not provide government subsidies, but still have pre-existing conditions covered if they are “qualified health plans” (ACA or Obamacare).

Recently, access to short-term health insurance plans has been expanded. These policies are designed to provide coverage during transition periods such as, when someone is unemployed or is coming off their parents’ health insurance plan. In most cases, short-term health insurance plans are only a viable option for applicants who are healthy and have few pre-existing conditions. Short term plans are not “qualified health plans” (ACA or Obamacare) and are medically underwritten.

In addition to this, association health plans have recently been expanded. Like ACA-compliant on exchange Marketplace plans, AHPs must provide coverage for pre-existing conditions to the extent that the plan covers that specific condition, and applicants cannot be rejected due to their medical history. They also cannot be charged a higher rate because of their health status. However, like short-term health insurance plans, AHPs have relatively “skinny” coverage, making them a realistic option only for healthy individuals.

In most cases, those with pre-existing conditions will not find the coverage that they need from an off-exchange NON-ACA (Obamacare) health insurance plan.

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Getting Great Health Insurance Coverage with Nevada Insurance Enrollment

Finding great health insurance that won’t break the bank is challenging enough, but shopping for health insurance when you have a pre-existing condition can feel even more daunting. If you’re looking for a health insurance plan that includes coverage for the prescription medications that you need and your preferred medical care providers, we’re here to help. At Nevada Insurance Enrollment, our health insurance agents specialize in helping Nevada residents wade through numerous options available to find a health insurance policy that fits their needs and budget. Our specialty is helping our clients enroll in qualified health plans (ACA/Obamacare).

Related Articles:

Buying Health Insurance with a Serious Pre-Existing Condition

Health Insurance in Nevada: On Exchange vs. Off Exchange

How to Choose the Right Health Insurance Plan

Health Insurance in Nevada: On Exchange vs. Off Exchange


Read More: Health Insurance in Las Vegas, Nevada


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