Prior to 2014, insurance companies could deny coverage to anyone with a “pre-existing condition“. Pre-existing conditions could include any health issues an applicant has prior to the time he or she applied for coverage that would classify them as a high risk for being insured. The pre-existing conditions could be anything, from asthma to cancer to pregnancy, and in almost every case, coverage could be denied or canceled after it started.
But now in 2016, under the Affordable Care Act (aka Obamacare) a health insurer can no longer deny you coverage as a result of a pre-existing condition. The companies are also prohibited from charging you more in monthly premiums on your policy due to such a condition. It is also unlawful to charge women more for coverage than men.
In addition, benefits can no longer be limited for people with pre-existing conditions. Once you’re covered, the insurance companies are not allowed to deny paying the costs of necessary treatments for any pre-existing conditions you may have under your coverage.
Simply put, the insurance companies are no longer permitted to deny anyone coverage under the Affordable Care Act.
Are There Any Exceptions?
Yes. “Grandfathered” policies, ones in which you enrolled on or before March 23, 2010 for yourself and/or any members of your family, are not bound by all of the rules the Affordable Care Act put it place. Instead, these policies are governed by the mandates and regulations in place prior to the Affordable Care Act being enacted into law. With these policies, the previous limitations pertaining to pre-existing conditions still apply.
There are some exceptions that also fall under the new laws as they pertain to costs of coverage. While an insurance company is not allowed to charge higher premiums due to gender or any pre-existing conditions, they are permitted to charge more for a policy based on your age. The older you are, the more expensive your premiums may be. However, there is a limit on those higher costs. Under the Affordable Care Act, these increased premiums can be no more than three times the standard rate of a policy.
Basics of Your Health Insurance Policy
Every policy issued for insurance coverage through a health exchange is mandated to offer basic health services related to impatient and outpatient care, maternity care, and wellness and prevention, in addition to many other medical services. With this in mind, the insurance companies have the power to devise a range of coverage plans to suit different customers as they see fit, as long as those plans comply with all state and federal regulations.
As many policies are very different from one another, it is crucial that you know exactly what your specific plan offers and the terms under which the policy provides the essential care that your premiums allow.
What About the Efforts to Repeal the ACA?
Despite repeated attempts by Republicans to repeal the Affordable Care Act, at this time there is no credible threat to the law or any of its basic protections. As of now, there is no need to worry that your coverage is going to be revoked or altered in any way that might lead your insurer from denying you the benefits of health insurance.