How to Find Cheap Health Insurance with a Pre-existing Condition

Fran
Fran Majidi
July 25, 2019

Not so long ago, it used to be that people with chronic illnesses, also called pre-existing conditions, had a nightmarish time getting insured. Like all types of insurance, companies didn’t want to insure high-risk people, folks who would actually use their coverage and cost money to protect. The insurance companies preferred counting on the majority of members not to need any medical services so that their premiums would take care of the pool of members who did need treatment or services due to chronic illness. And the people who needed insurance the most paid the most. 

One of the most groundbreaking facets of the Affordable Care Act (ACA) of 2014 was that health insurance companies are no longer able to refuse coverage to people who have a pre-existing condition, which includes health problems that began before the start date of the new health coverage. That means that you will not be turned down for having asthma, diabetes, cancer, obesity, lupus, sleep apnea, multiple sclerosis, epilepsy, high blood pressure and a whole list of other chronic ailments. You also can’t be charged more for having a pre-existing condition. You will continue to be covered for treatment for whatever disease or condition you may have without any limits placed on the care you receive. 

The majority of Americans’ healthcare coverage is through employer-sponsored health plans but even they are affected. Read more below and make sure to compare health insurance quotes to get the best deals on your health insurance plan this year.

Pre-existing Conditions: Are There Exceptions for Grandfathered Plans?

Yes, there’s an exception about refusal for coverage for grandfathered plans. A grandfathered health insurance plan is one that you bought on or before March 23, 2010 and has remained the same without reduction of benefits or an increase in price. If you have a grandfathered plan, your insurer may raise your rate or deny you coverage. However, there are many private and government sponsored health plans that will cover you despite your chronic illness(es).

Does Pre-existing Condition Insurance Plan (PCIP) Coverage Still Exist?

No, as of April 30, 2014, the PCIP program no longer exists. PCIP used to provide coverage options for people who were uninsured at least six months and had a pre-existing condition and were denied coverage or were denied coverage for the treatment of the pre-existing condition. Now, anyone can get health insurance through the marketplace.

Are There Limits with Marketplace Healthcare Coverage?

The ACA prohibits health insurance companies from putting an annual or lifetime limit on most healthcare benefits. It used to be the norm for health insurers to put a lifetime limit on a plan and require the insured to pay for costs that surpassed the limit. They are now allowed to only place dollar limits and lifetime dollar limits on services that are not considered essential.

How Else Does the ACA Affect My Healthcare Options?

Not only did the ACA make it illegal for an insurer to turn down a consumer with a pre-existing condition but it also made healthcare more affordable for low- and moderate-income families. The ACA also added protections to employees of businesses, who often had bare coverages or difficulty getting the care they needed.

Now, preventive services are included in employer-sponsored coverage. That includes screenings, immunizations and annual check-ups. It used to be that sometimes employees had to wait up to 12 months to get coverage for a pre-existing health condition. 

The ACA also requires that dependents up to the age of 26 be allowed coverage under a parent’s plan. This demographic used to be one of the largest groups of uninsured people. 

There is also a cap now of how much an individual is expected to pay for healthcare costs out-of-pocket. There used to be no limit, and costs were often crippling. 

After you’re enrolled, your health plan cannot suddenly raise your rates based on your health

If you’re on Medicaid, you can’t be refused coverage or be charged because of your pre-existing condition. 

Can I Be Denied Coverage if I’m Pregnant?

Pregnancies are treated much like a pre-existing condition. If you’re pregnant when you apply, you can’t be rejected or charged more because of your pregnancy. You’re covered from day one of enrollment.

Also, the birth of your child qualifies you for the special enrollment period, meaning you are allowed to change your plan outside of the open enrollment period. 

Is Private Medical Coverage More Expensive than Health Insurance Through the Marketplace?

Not necessarily. Sometimes private health insurance is less expensive. Your best bet is to get free health insurance quotes and compare rates to see which one is more affordable. Prices are competitive for private coverage and you may find it to be more cost effective than the plans sold through the marketplace.

Is it Cheaper to Add a Spouse or to Have Separate Plans?

You may be able to find better deals choosing separate plans. You should look into both options and compare health insurance quotes.

Things to Consider When Shopping for a Plan if You Have a Chronic Condition:

  • Choose a plan that has your doctor as an in-network provider or else you may pay for appointments out of pocket.
  • Check the plan’s drug formulary to estimate what your prescription drug costs will be out of pocket.
  • Self or Care Management programs are covered in plans found in the ACA marketplace.
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