What Are Preexisting Conditions?
This refers to any healthcare issues you had prior to your health insurance plan’s effective date.
Buying Health Insurance
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.
You may assume that since you have a preexisting 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.
Are Preexisting Conditions Covered?
Preexisting 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 preexisting 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.
Health Insurance plans can no longer discriminate based on preexisting conditions. Prior to 2014, when purchasing individual healthcare with a preexisting condition, an insurer might have declined covering your condition, or they might have denied you coverage altogether. However, now with the Affordable Care Act, 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 preexisting condition.
There will no be annual or lifetime limits on the 10 Essential Health Benefits. It no longer matters what medications you are on, your height or weight, how old you are, how young you are, your gender, what preexisting conditions you have, if you are pregnant, if you’ve had a ton of medical bills in the past, genetic information or disabilities. Nothing matters. You qualify. You cannot be turned down for health issues.
Some factors that may affect your premium is if you smoke, your age, the number of family members you are covering, and your income. But factors affecting your health will no longer cause your premium to go up in price.
Can I Get Covered?
While it’s now much easier to obtain health insurance coverage for preexisting conditions, not every health insurance plan provides coverage for those with previously diagnosed medical conditions. If you have a preexisting 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 preexisting conditions.
On-Exchange vs. Off-Exchange
On exchange marketplace health insurance plans (Nevada Health Link) and Off Exchange ACA plans are both required to provide coverage for the 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 device
- Laboratory services
- Preventative care and wellness services, including chronic disease management
- Pediatric care
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On Exchange Marketplace Plans
In addition to the 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.
Off Exchange Health Insurance Plans
Off exchange plans do not provide government subsidies, but still have preexisting conditions covered if they are “qualified health plans” (ACA or Obamacare).
In most cases, if you have a preexisting 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 preexisting 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.
Short Term Health Insurance
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 preexisting conditions. Short term plans are not “qualified health plans” (ACA or Obamacare) and are medically underwritten. We recommend that you use these plans sparingly if possible. Please check with your agent if you can qualify and/or afford a qualified health plan as a first option. Your window of getting into a qualified health plan is normally 60 days, and once that window is closed, you have to wait for the next open enrollment period, unless you have a “life event” like marriage, birth, etc.
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Association Health Plans
In addition to this, association health plans have recently been expanded. Like ACA-compliant on-exchange Marketplace plans, AHPs Association Health Plans
must provide coverage for preexisting 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 preexisting conditions will not find the coverage that they need from an off-exchange NON-ACA (Obamacare) health insurance plan.
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 preexisting injury or illness no longer have to go through a waiting period for their preexisting conditions to be covered. For this reason, coverage can generally only be purchased during the Open Enrollment period which is November 1st through January 15th each year.
There are a handful of qualifying life events such as, a change in residence from one state to another (by doing so, losing coverage in the state you are moving from), birth or adoption of a child, etc. These life events will trigger a “special enrollment period” and allow you to enroll/make changes without having to wait for your plan to start the next open enrollment. If you don’t have a “life event” or it’s not “open enrollment”, you will have to wait until the next “Open Enrollment” period.
Let Nevada Insurance Enrollment Help You Choose Your Health Insurance Plan
Finding great health insurance that won’t break the bank is challenging enough, but shopping for health insurance when you have a preexisting condition can feel even more daunting. Having a licensed Nevada health insurance agent help you find a health insurance plan is particularly important when you have a serious preexisting condition. They will guide and advise you, so you are not misled into getting a health plan that has insufficient coverage or is not an ACA (Obamacare) type plan.
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).
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Recent Posts
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Finding a health insurance plan that covers your preferred healthcare providers and necessary medications can be a challenge, especially if you split your time between two states or travel frequently.
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On the employer’s end, providing health insurance can be costly and complicated. However, it can also be a reliable way to bring in new hires, improve productivity and boost morale and job satisfaction. Small businesses that want to provide this benefit have options that let them do so affordably.
Surrogacy Laws in Nevada
Generally speaking, the intended parents are responsible for covering pregnancy-related expenses, including complications that may arise over the course of the pregnancy and delivery. The standard way to control health care costs is to purchase health insurance for the woman acting as the gestational surrogate.
Will Health Insurance Cover Rhinoplasty?
As is the case with all elective surgeries, rhinoplasty is not covered by health insurance when the procedure is not medically necessary. Cosmetic rhinoplasty changes the overall appearance of the individual’s nose by reshaping it or reducing its size.