Can you be denied health coverage because of a pre existing condition?
Edward Neeman | Published: June 14, 2018
Understanding health insurance coverage can be a daunting task. Copays, deductibles, out-of-pocket costs, pre-existing conditions, PPO, HMO. The list goes on and on. But what does it all mean? Researching these topics in conjunction with exploring personal health insurance options is key in order to avoid paying for extensive bills and fees from your own pocketbook.
Basic Health Care Coverage
Prior to the introduction of Obamacare, many basic health coverages were limited or subject to a deductible. Insurance companies were allowed to base acceptance and pricing of each individual by the relevance of pre-existing conditions. Many individuals simply went without, because they could not afford ongoing care, well visits, or management medications.
After President Obama took office, he promised to establish the ACA, aka the Affordable Care Act. This plan was meant to provide affordable health insurance too much low income and middle-class families. Through this act, the ACA determined that insurance companies could not form a bias based on pre-existing conditions or pregnancy, routine visits for individuals of all genders would be covered, and medications to prevent pregnancy (birth control) would be covered at no charge.
In fact, women's reproductive health and rights saw some of the biggest changes with the introduction of the ACA including free birth control and free breast pumps for working mothers. Disallowing pregnancy as a pre-existing condition exclusion. It had women's rights covered.
How Has Healthcare Changed?
You may recall that affordable health insurance was one of the biggest hot topics in the recent election. While many Republicans felt that Obamacare actually increased the cost of the healthcare for those it was made to protect, Democrats felt that the nation had not given this form of health insurance enough time to succeed. Now many Americans are stuck in limbo between a labyrinth of Obamacare era provisions and Trumpcare regulations. Most Americans are also seeing their premiums increase significantly, especially if they are enrolled in an HMO plan through the affordable care act. Trumpcare stipulations have stripped away many subsidies that were once allowed to help pay for healthcare costs leaving many Americans with high healthcare premiums.
How Has Healthcare Stayed the Same?
The good news is that many of the basic provisions of health care coverage have not changed. Here are some major points of healthcare that have remained the same through this transition:
The amount that must be paid before insurance kicks in and picks up any of the cost of tests, procedures, and medications. Oftentimes, there are separate individual and family deductibles.
This is the maximum amount that any person or family should have to pay out-of-pocket for health care costs. It is similar to a deductible in the fact that there may be separate individual and family out-of-pocket maximum amounts.
The amount that insurance pays towards health care costs after the deductible is met. This is often set as a percentage, and the coinsurance amount is usually higher for providers who are in-network for an HMO plan.
Pre Existing Conditions
Conditions that were present in an individual prior to obtaining health insurance. Pre-existing conditions were a major concern prior to Obamacare because health insurance companies could deny coverage or raise premiums for an individual with previously diagnosed illnesses.
Insurance still pays for a portion, if not all, of birth control costs. Pregnancy and related procedures are covered, as well as are maternal and new baby checkups.
Although applicants can no longer be denied for pre-existing conditions, finding affordable health insurance can be difficult. Selecting a plan that is both affordable and provides adequate coverage is key. Applicants should not pay for what they don't use. However, obtaining coverage for preventive care is also important. While many plans boast low premiums in exchange for high deductibles, many consumers are left without coverage for routine care. Balancing deductibles, co-pays, and the outlook for emergency care is beneficial to select the insurance plan that is right for you and your family.
Those with pre-existing conditions may also opt to supplement their primary health insurance plan with other plans that cover routine care. Combining plans may also be a great option for those who need both an emergency plan and one for preventive care but can't afford an insurance plan that covers both.