Pre-existing Conditions

The Affordable Care Act (ACA) - also called Obamacare - is a new law helping more Americans get health insurance. This guide will help you understand how it's affecting those with pre-existing conditions.


And if you're overwhelmed, don't worry! Just call or email us. We're trained and authorized to help.


You can't be declined for new health insurance plans.

Before ACA, insurance companies could turn you away if you had a pre-existing condition, but now the law has changed that. You are guaranteed approval regardless of your pre-existing conditions or how often you use your insurance plan.  


You can't be charged higher premiums because of pre-existing conditions.

If you've been paying high premiums because of a pre-existing condition, you're in luck. Under the new law, health insurance companies can't charge you higher rates because of a pre-existing condition anymore. No, really.


Pre-existing conditions are covered, always.

No more worrying about whether or not your health condition is covered. Insurance companies must cover your pre-existing conditions on all new health plans. 


Changing insurance companies might be best for you. 

Maybe you've been stuck in your high-priced policy for years because you couldn't qualify for a new plan. So now might be the best time to move to a new insurance company and take advantage of the new rules. But remember: you must apply during Open Enrollment. 


You're required to have health insurance, or pay a penalty. 

Unless you qualify for an exception, you're required to have health insurance or pay a penalty starting in 2014. Qualified insurance could be job-based coverage (your's, your spouse's, or your parent's), private health insurance, Medicaid, Medicare, or another government-sponsored plan. 






Maternity is covered.

No insurance company can turn you away because you're pregnant. And pregnancy is always covered. If you anticipate a pregnancy in the upcoming year, you might want to consider a higher benefit plan like Platinum or Gold. 


Dental and vision care for children under age 19 is included now.

Is your child due for a dental cleaning? Is he or she squinting to see the board at school? You're in luck. All new health plans must include dental and vision care for kids as part of your required Essential Benefits package. 


All plans cover Essential Health Benefits with no yearly or lifetime limits. 

All plans must include coverage for certain benefits with no limits, so you can't run out of insurance. Essential Health Benefits include doctor office visits, hospitalization, prescriptions, preventive care, and more. 


You'll get free checkups.

Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include 100% coverage for preventive care - things like physicals, labs, screenings, pap smears, mammograms, PSA tests, colonoscopies, and more. Preventive care for children is also included. 






Age-based pricing is different under the new law.

Before ACA, an insurance company might charge an older adult six times more than a younger adult for the same policy. But now, insurance companies can only charge three times more for an older adult, causing many older adults to see lower rates based on age alone. 


If you're under 30, you have some more options to lower your costs.

Anybody under 30 has the option of choosing a low-cost "catastrophic plan" in addition to the four plan choices (Platinum, Gold, Silver, Bronze). Up until your 26th birthday, you can be insured on your parent's plan under ACA. It does not matter if you're a student, if you're married, or if your parents claim you as a depedent. Up to age 26, you're covered under your parent, no questions asked.


Medicaid is expanding to cover more people.

Before ACA, the income cut-off for 100% Federal Poverty Level (FPL) for Medicaid, but that has be raised to 138% under the new law. Medcaid varies by state, and not every state chose to expand the program. If your state didn't expand Medicaid and you would have qualified, you can enroll in a private health plan for as little as $1 per month based on family size and household income.


See if you qualify for discounted plans.

You can qualify for a tax subsidy to be applied toward your private individual health insurance plan. A tax subsidy is the amount of money the government will pay directly to your brand-name insurance company to make your private health plan affordable. The amount of subsidy you receive, if any, depends on your family size and household income. Use our calculator to see if you might qualify. Or, contact us. We're trained and authorized to walk you through the process.







Choose your insurance company. 

Even if you accept a tax subsidy -  where the government helps pay your health insurance costs so your plan stays affordable - you still have the power of choice. Obamacare plans are not insured by the government. They are insured by private, brand-name insurance companies like BlueCross BlueShield, United Healthcare, Humana, Kaiser Permanente, and more. Choose your favorite insurance company from the ones available in your area.  


Choose your benefits. 

Whether you qualify for a tax subsidy or not, you'll still be choosing from five categories of plans: Platinum, Gold, Silver, Bronze, or Catastrophic. Use our Plan Guide to help you decide which plan is best for you.


The benefits are the same for on-exchange and off-exchange plans.

ACA says that on-exchange (where the government pays part of your premium to make it affordable) and off-exchange (no government subsidy) plans must be identical in your area. So if you accept a tax subsidy, you will not give up any benefits.


You might notice fewer doctor choices under ACA.

There's always a catch, isn't there? You might notice a smaller provider network - or doctors and other healthcare providers who accept your health plan - for on-exchange plans (government subsidy to lower premium). This isn't the case every time, so if you have a favorite doctor, you'll want to make sure they accept the plan before enrolling. 


Choose how you want to sign-up.

You can enroll in on-exchange or off-exchange plans several ways: 1) Enroll online through the exchange (website) 2) Enroll over the phone by calling us 3) Enroll in-person with a local agent at one of our office locations. You can still qualify for subsidy regardless of which method you choose.