Question About ACA and Pre-Existing Conditions

[Frappa Chino]

As has everyone I've read all over the news how ACA stops insurance companies from being able to reject people for pre-existing conditions.

But does this apply across the board to all insurance companies 365 days a year? i.e. I walk down to my local insurance agent today and buy insurance? Or does it apply only to individuals buying insurance on the ACA exchange during the enrollment period?

Or how about if I get hired by a small business that offers a plan through the ACA?

Thanks

 

[timsip]

As has everyone I've read all over the news how ACA stops insurance companies from being able to reject people for pre-existing conditions.

But does this apply across the board to all insurance companies 365 days a year? i.e. I walk down to my local insurance agent today and buy insurance? Or does it apply only to individuals buying insurance on the ACA exchange during the enrollment period?

Or how about if I get hired by a small business that offers a plan through the ACA?

Thanks

On or off the exchange, all ACA compliant plans are restricted from denying coverage due to pre-existing conditions. Also note that you can only sign up for health insurance during open enrollment which ended March 31st this year. That is unless you have a qualifying event. Consult a local health insurance agent for guidance on that.

 

[Frappa Chino]

On or off the exchange, all ACA compliant plans are restricted from denying coverage due to pre-existing conditions. Also note that you can only sign up for health insurance during open enrollment which ended March 31st this year. That is unless you have a qualifying event. Consult a local health insurance agent for guidance on that.

Right, a person must sign up by March 31st if they want to receive a subsidy. My question applies to a person who wants to get coverage now but without a subsidy. Can the insurance company turn them down because they have a pre-existing condition?

Ditto if that person were to sign up through an employers health plan.

 

[WCMason]

Right, a person must sign up by March 31st if they want to receive a subsidy. My question applies to a person who wants to get coverage now but without a subsidy. Can the insurance company turn them down because they have a pre-existing condition? Ditto if that person were to sign up through an employers health plan.

Subsidy or no subsidy has no bearing on insurability. Including EGHP. Especially EGHP.

 

[timsip]

Right, a person must sign up by March 31st if they want to receive a subsidy. My question applies to a person who wants to get coverage now but without a subsidy. Can the insurance company turn them down because they have a pre-existing condition?

Ditto if that person were to sign up through an employers health plan.

The only way you can get a plan now, subsidy or not is if you qualify for a Special Enrollment Period. If you do, then no, a carrier can not turn you down due to pre-existing conditions. Same is true, as far as I know (not a group expert) for employer plans, but they too typically have enrollment periods.

 

[yorkriver1]

There are plans of short term medical that can be purchased now that don't meet the strict requirements of the ACA list of essential coverage.
The STM's as they are known do have medical questions. It's easy to get quotes for these plans, but there are some people who would be turned down.
There are a few employers that for the rest of 2014 have older group plans. These older plans can exclude pre-existing conditions for up to 12 months, depending on whether the new hire had continuous prior coverage before being hired.
All that was said by others posting here is true of ACA compliant plans, those with effective dates no earlier than 1/1/2014, or first became available to purchase after that date.
A short term medical plan can be a useful bridge to 1/1/2015 if there is no qualifying event leading to ACA plan eligibility before then. Shop carefully. While many of them have lower deductibles, they are often not designed like the group insurance many find familiar. Be sure to read the information carefully/ask lots of questions.

 

[Frappa Chino]

The only way you can get a plan now, subsidy or not is if you qualify for a Special Enrollment Period. If you do, then no, a carrier can not turn you down due to pre-existing conditions. Same is true, as far as I know (not a group expert) for employer plans, but they too typically have enrollment periods.

I'm not sure why we aren't on the same page but I've said twice now that I'm not asking about buying a plan on the exchange, so I'm not sure why you keep saying "the only way that you can get a plan now is if you qualify for a Special Enrollment Period".

Yes, the enrollment period is over for the exchange for this year, but surely you aren't saying that a person can no longer buy insurance on the free market?!

 

[Yagents]

No such thing as a free market anymore. And yes, we r suggesting that you can't buy a policy off the exchange either without sep

 

[Frappa Chino]

Ah OK, I had no idea, sorry for the confusion. I thought the cutoff date was for people that wanted to qualify for subsidies and/or avoid a fine come tax time. I'll probably be back with more questions once I digest this and do some more research.

 

[Yagents]

Talk to an agent in your state, the truth will depend on the state you live in. For example, AZ is one of the few states that does have a carrier that is selling year round off the exchange. But, not many states have this situation.

Medicaid is open year round in states that expanded medicaid