US Healthcare System Explained - Here’s How It WorksRead More
Updated: January 25, 2019
Finding an affordable health insurance plan is often one of the most challenging and frustrating experiences you’ll have to go through. Now, if you are living with a pre-existing condition or chronic illness, that frustration will almost certainly double. If you are one of the millions of Americans looking to find affordable private health insurance to cover your pre-existing conditions, here’s what you need to know.
Health Insurance And Pre-Existing Conditions
Before getting started, it’s a good idea to have a background on the relationship between health insurance and pre-existing conditions.
Prior to 2014, when the Affordable Care Act went into effect, health insurance companies were loosely regulated. Meaning, they were able to do whatever they wanted to boost their profits, which was bad news for high-risk individuals. Here’s why.
In an extremely brief overview, health insurance works by having a ton of members all pay monthly premiums into what is known as a risk pool. The health insurance companies bank on the fact that the majority of members will not need any medical services, and will use the risk pool for the members who do need medical attention. In order to prevent the medical bills from stacking up, it’s in the best interest of the companies to eliminate high-risk individuals or charge them a higher monthly premium. That changed after 2014.
Does Health Insurance Have To Cover Pre-Existing Conditions?
If you are purchasing coverage through the health insurance marketplace, then your health insurance plan is not only required to cover your pre-existing condition but charge you the same amount of money as if you didn’t have any chronic illness or disease. If you are purchasing health insurance outside the marketplace, then insurers are not required to cover your pre-existing condition.
Can You Get Private Medical Coverage?
Contrary to what many may think, private health for your pre-existing condition is an affordable option. With the rising prices of health insurance premiums through the marketplace, more Americans are turning to the private marketplace for coverage.
Yes, private health insurance companies do have the ability to deny you coverage, and even charge you more for your pre-existing condition, but there is a chance that it will still be cheaper than your options through the marketplace.
Employer Health Plans
The majority of people get health insurance through their employer, and it has been that way for a while. The rules surrounding employer-sponsored coverage also changed after the Affordable Care Act as well.
Prior to Obamacare, if you had a pre-existing or chronic condition and you were eligible for employer-sponsored coverage, you probably had to go through a pre-existing exclusion waiting period. The exclusion waiting period wasn’t short either, it was usually limited to 12 months, or 18 months if you enrolled late. The good news is that the waiting period would only apply to you if you had gotten treatment within 6 months of enrolling in your new plan.
After Obamacare was passed, those rules were thrown out the window. Today, if you are part of your employer-sponsored health insurance plan and you have a pre-existing condition, you will be covered. There is no longer an exclusion waiting period.
Meeting Your Needs Through The Private Marketplace
Depending on what needs you need to meet, finding affordable health insurance can be a seemingly impossible task. We suggest that you carefully review your needs and see which can be fulfilled by what’s available on the market. Here are a few things to consider:
- Is your current doctor included in your plan? It’s best to choose a plan that doesn’t have your doctor out of network, or else you may need to pick a different doctor of pay out pocket for appointments.
- Do you want one plan or separate plans? Adding your spouse to your plan may seem like a good idea, but not everyone should. In fact, you may be able to find better deals by choosing separate plans instead.
- Don’t pick a plan that doesn’t offer you what you need. This is especially important with pre-existing conditions, no matter if you are dealing with a heart condition or pregnancy. The last thing you want is useless add-ons that will only increase the cost of your health care coverage.
Purchasing Private Insurance
If you are not covered by your workplace and do not wish to use the public healthcare marketplace, you will need to purchase individual insurance from a private marketplace. There is no need to worry about finding an insurance plan that will cover your pre-existing conditions as insurers cannot discriminate or limit coverage because of it. However, there are still a few factors that you should take into consideration when choosing your plan.
In a private health insurance marketplace you can:
- Get access to free re-enrollment services
- Speak with local agents who can help you find an HMO that meets your needs
- Access to resources to help you find the right coverage
- 24/7 health insurance quotes
Find A Private Healthcare Plan With FirstQuote Health
Regardless of whether or not you have a pre-existing condition, FirstQuote Health can help you find affordable health insurance plans. Compare quotes in your area by entering your zip code, and get covered today.