After our spurt of healthcare reform blogs, we thought we’d get back to basics with a question that affects so much of our healthcare and health insurance. We hear about them all the time, they jack up our health insurance premiums, and supposedly healthcare reform is going to help those of us with them, but what is a pre-existing condition anyway?
What Is a Pre-Existing Condition?
At its most basic, a “pre-existing condition” is any condition or illness that existed before the first day of coverage of a new health insurance plan. Because any condition or illness can translate into significant losses by a health insurance company, it is very much in their interests to avoid covering anyone with a known pre-existing condition as much as possible. Not all pre-existing conditions have a significant effect on health insurance coverage, but if you have ever tried to find affordable health insurance coverage for someone with a pre-existing condition, you know how difficult it can be.
If I Have a Pre-Existing Condition, What Are My Options for Health Insurance?
Pre-healthcare reform, your best bet to find affordable health insurance coverage if you have a pre-existing condition was through group health insurance coverage such as through an employer. Unlike individual health insurance coverage, group health insurance coverage has the luxury of many members among whom they can spread the risk and costs of a member’s pre-existing condition, and under federal law, you cannot be charged more for your group health insurance coverage as your young and healthy colleague.
However, if you did not have group health insurance, purchasing an individual health insurance policy could be very tough and expensive going, indeed. Depending on your pre-existing condition, the available health insurance coverage was often both expensive and skimpy on the benefits, and that was if health insurance coverage was available at all.
Some states do offer a high-risk health insurance pool to residents with pre-existing conditions as an option for health insurance. However, although the state high-risk health insurance pools are a significant benefit to many with pre-existing conditions who can’t otherwise get health insurance, in most cases high-risk pool health insurance still involves high health insurance premiums, skimpy high deductible health insurance benefits, and long wait lists.
Does Healthcare Reform Help Americans with Pre-existing Conditions At All?
Healthcare reform extends two major helping hands to folks with pre-existing conditions:
Starting in 2014, health insurance companies will be barred from denying health insurance to applicants on the basis of a pre-existing condition. Health insurers will be required to offer health insurance to everyone regardless of their health status.
In the meantime until 2014, interim high-risk health insurance pools will be available to Americans with pre-existing conditions who have been without health insurance for at least six months. Health insurance premiums will be based on the standard cost of an individual health insurance policy in the area, and out-of-pocket costs will be capped at $5,950 for individuals and $11,900 for families. In addition, older high-risk health insurance pool members can at most be charged 4 times more for their insurance than younger health insurance pool members.
For more on pre-existing conditions, health insurance, and high-risk health insurance pools, visit MyHealthCafe.com:
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- Healthcare Reform: Pre-existing Conditions and the Federal Health Insurance Pool
- Healthcare Reform: the Pregnancy as a Pre-existing Condition Question
- Unemployed and Have a Pre-existing Condition? Are You a Candidate for a State High-Risk Pool?
- Healthcare Reform: Immediate Changes for Health Insurance and Pre-Existing Conditions
- Healthcare Reform for Americans with Pre-existing Conditions: the State High-Risk Health Insurance Pools vs. the Interim High-Risk Health Insurance Pools