Full Circle: The HHO Blog

Health Insurance and Pre-Existing Conditions: Do They Matter?

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Looking for health insurance is transitional and transactional. You want to find the best possible policy to cover your existing needs and to find the value in your premiums that will justify the expense. If you don’t use health insurance too often, a metal (Obamacare) plan may not feel like the best value for you. If you just concluded a job or career, for whatever reason, and are on the lookout for a new opportunity, COBRA may not feel like the best route for you.

 Whether you’re shopping for the first time or looking for something to replace existing coverage, we can help. In this article, let’s discuss one of the most commonly asked questions we hear: how pre-existing conditions affect a policy purchase, and what to expect if you have such a condition.


Understanding Pre-Existing Health Conditions and Health Insurance


Before the Affordable Care Act passed in 2010, health insurance carriers could decide to limit the issuance of health insurance to those with certain pre-existing conditions. Some of the most common pre-existing conditions that were denied during the application process included:

        High blood pressure or heart problems

  •       Diabetes
  •       Asthma

 Additionally, obesity or obesity-related illnesses were (and still are) considered a risk factor by insurance companies, and applications could be denied based on other factors included in the application.

 When the ACA passed, pre-existing conditions could no longer be used as a reason for denial, and premiums could not be increased due to any pre-existing condition. However, insurance companies are still able to drive premium prices based on specific risk factors. These include:

        Weight - So while you cannot be denied health insurance due to weight, you may pay a higher premium if you’re obese or overweight.

  •       Age - Older Americans on average are expected by companies to have more health problems and require more care; thus premiums are higher.
  •       Tobacco Use - Smokers pay exponentially higher rates, sometimes up to 50% higher. The increased premiums for smokers have not led to smoking cessation; rather fewer smokers on average tend to purchase insurance due to the increased cost (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589079/)


At one time, insurance companies may have charged women more for the same plan than men, but this practice is no longer allowed under the ACA.


So, What About Private Plans?


Many national or state healthcare plans were “grandfathered in” for those Americans purchasing a plan who did not want to change out of their plan or shop for a marketplace metal plan. Private company policies set up before the ACA passed were not subject to the new law; meaning, someone who had an existing policy and didn’t want to change it may still have been denied coverage due to a pre-existing condition. In the case of any new policy, the ACA guidelines are in effect - meaning, you can’t be denied coverage based on a pre-existing condition.


Knowing This, How Do I Shop?


If you’re priced out of private insurance options due to obesity, tobacco use or other factors, metal plans might be the best way to go for you. The advantage of working with agents who know the market is your ability to select and afford a plan that gives you maximum coverage based on your specific needs.


This is where Healthy Halo comes in. Aside from being affordable, your health insurance policy should cover you and your family’s existing healthcare needs comfortably, and even provide a little extra if possible. For instance, if your last policy didn’t include vision, we can try to find you something around the premiums you’re used to paying that will also include vision, dental, or other coverage.


Standing By To Help You

Our licensed benefits advisors are standing by to help you with any questions you may have.

Call (877) THE-HALO

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