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Treating Cancer as a Pre Existing Condition

Meredith Miller | Published: June 14, 2018

Researcher holding blood samples

Cancer is an incredibly devastating disease that impacts millions of lives every year. Treatment is often very expensive, even with health insurance. It is made even more difficult by the fact that most health insurance companies consider cancer to be a pre existing condition. Many other common ailments are also considered to be pre existing, like asthma, diabetes, and pregnancy. Currently, the ACA protects those with pre existing conditions by preventing them from paying more or having coverage denied by an HMO. However, this situation could change soon.

Pre Existing Conditions

As mentioned above, cancer is considered a pre existing condition. A pre existing condition is defined as any health issue that a person had before they enroll in a new health insurance plan. This includes conditions that are currently being treated and conditions that were treated in the past. Since there is no official definition, healthcare providers decide which conditions fall into this category. A few health issues that are defined as pre existing include cancer, acne, pregnancy, and more. According to recent research, more than half of Americans under the age of 51 may be living with a pre existing condition.

Before the ACA

Before Obamacare was passed, insurance companies were allowed to deny coverage to an individual with pre existing conditions like pregnancy or MS. They also often charged people with these conditions higher premiums, often making it difficult to find affordable health insurance. An HMO could also provide health insurance but exclude coverage for the individual’s pre existing condition. Many cancer patients were denied healthcare or charged exorbitant rates that they could not afford. These sorts of pre existing conditions exclusions were very prominent. They were even more prevalent in the individual health insurance market.

Protections for Cancer Patients

Under the Affordable Care Act, also known as the ACA, an HMO is no longer allowed to discriminate against an individual just because they have a pre existing condition. This bill makes healthcare more affordable and accessible for cancer patients of all socioeconomic backgrounds. According to the new regulations put forth by the Affordable Care Act:

  • You cannot be refused insurance because of a pre existing condition.
  • You will not be presented with higher premium rates if you have a pre existing condition.
  • Your insurance company cannot refuse to pay for treatment for pre existing conditions.
  • Insurance companies cannot limit the amount they pay for healthcare annually or in your lifetime.

In previous years, insurers could stop paying for insurance after it reached a certain amount. This is known as an annual or lifetime cap. Unfortunately, cancer treatment is very expensive and a lot of patients experienced the negative effects of this cap.they would have to pay for care out of pocket once their coverage stopped. Thankfully, this is no longer the case. Your insurance company must continue to pay for your care, no matter how expensive it is.

The AHCA

Though it is not certain at the time, it is likely that these protections would change under the new health insurance repeal. Congress is currently trying to repeal and replace Obamacare with the American Health Care Act. This bill is also called the AHCA or Trumpcare.

It would leave it up to the states to determine whether or not insurance companies would be allowed to charge higher premiums to people with pre existing conditions like cancer and pregnancy. If passed, the new healthcare bill could leave many cancer patients priced out of health coverage. This would essentially turn back the clock to the pre-Obamacare days. Even though Trumpcare has not yet been passed, it is safe to say that many cancer patients and others with pre existing conditions may suffer because of it. The best thing you can do to prepare for the new healthcare bill is to find the most affordable health insurance plan with the best coverage for your needs. Use a website like First Quote Health to locate and compare affordable health insurance plans in your area. All you need to do is enter your zip code and let the website do the rest.