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Can I Be Denied Health Insurance Coverage Under Obamacare?

The Affordable Care Act, commonly referred to as Obamacare, was signed into law by President Barack Obama on March 23, 2010. One of the law’s main purposes was to make quality health insurance coverage more affordable and more accessible to American consumers. The last major provisions of Obamacare were rolled out in 2014. That’s when big changes were made prohibiting insurance companies from denying health coverage or increasing monthly premiums for those with pre-existing medical conditions.

In this article, we’ll look at how it was possible to be declined for health insurance coverage before Obamacare’s 2014 provisions and whether or not it’s possible to be declined, or charged more, for coverage today.

Before 2014: Getting declined for pre-existing medical conditions

Before Obamacare, being denied health insurance coverage due to a pre-existing medical condition was a frustrating reality for many Americans. And the few people with pre-existing conditions who were able to get coverage often had to pay significantly more for their coverage than those without pre-existing conditions.

Prior to 2014, when the new consumer protections of the Obamacare law came into effect, a person’s medical history could make it possible for health insurance companies to decline health coverage for a broad range of past and present medical conditions, even if the applicant was no longer suffering from the condition.

Though practices varied by states and by insurance companies, it was common to have your health insurance application declined if you had ever been diagnosed with any of the following conditions:

  • Heart disease
  • Cancer of any kind
  • Diabetes
  • Asthma
  • Arthritis
  • High-blood pressure

Unfortunately, denial of health coverage wasn’t just limited to people currently dealing with one of these serious medical conditions. Even relatively minor ailments could potentially result in the decline of a health insurance application prior to 2014. People who had their medical issues under control or had not suffered from them for years were still denied health coverage.

Some people with pre-existing medical conditions were approved anyway, but they often had to pay twice as much for their monthly premiums as those without pre-existing medical conditions. Even when they were approved, the health insurance companies were allowed to deny future coverage for medical associated with those pre-existing medical conditions.

Since 2014: Health coverage for pre-existing medical conditions under Obamacare

Obamacare makes it more difficult for a person to be denied health coverage. Starting in 2014, pre-existing medical conditions could no longer be used to deny anyone health insurance coverage. In addition, treatment of a pre-existing condition cannot be excluded from your health coverage and a person can’t be charged more due to his or her medical history or based on the presence of a pre-existing medical condition.

In short, thanks to Obamacare, no one needs to worry about being treated differently by health insurance companies when it comes to pre-existing medical conditions.

Can anyone be charged more for health coverage under Obamacare?

Obamacare made health insurance coverage more accessible and affordable to those with pre-existing medical conditions. However, there are factors that can influence how much you are charged for coverage under Obamacare, and it’s not always possible to get Obamacare coverage exactly when you want it.

There are a few factors that can result in a person paying higher monthly health insurance premiums under Obamacare. These factors include:

  • Where you live – The cost of medical care varies from one city or state to the next, and some communities are generally healthier than others. That’s one reason why what you’re charged for coverage may be different than what your cousin is charged two hours away.
  • Your age – Older folks tend to use more medical care than younger folks, which means they’re more expensive to insure. Under Obamacare, health insurance companies are allowed to charge older customers up to three times what they would charge younger customers for the same health insurance plan.
  • Whether or not you smoke – Obamacare also allows health insurance companies to charge smokers 50% more for their health insurance than non-smokers, though rules governing premiums for smokers can vary from one state to another. Some states, like California, prohibit insurers from charging smokers more for coverage.

When can I sign up for health coverage under Obamacare?

As mentioned, you can no longer be declined for coverage under Obamacare based on your personal medical history. However, that doesn’t mean that you can simply purchase an Obamacare-compliant health insurance plan any time you want.

Obamacare has made it easier and less costly for many people to access health insurance coverage, but there are a few things to keep in mind. First of all, you should know that you have to sign-up for health coverage under Obamacare during the nationwide open enrollment period or during a special enrollment period:

  • The nationwide open enrollment period: This is the period when any qualified person can enroll in an Obamacare-compliant health insurance plan. Though dates are subject to change, the Obamacare nationwide open enrollment period is scheduled to occur every year, beginning on November 1 and ending January 31.
  • When you have a qualifying life event: You can also enroll for health coverage under Obamacare within 60 days of experiencing a qualifying life event. Qualifying life events are major changes in your life which may include the loss of employer-based health coverage, a permanent move to a new coverage area, marriage or divorce, the birth or adoption of a child, changes in your income that affect the health coverage you qualify for, etc. You may be required to provide proof that you have experience a qualifying life event before you are granted a personal special enrollment period.

Things to be aware of:

It’s important to know that not all life changes count as qualifying life events. For example, simply getting sick or even being diagnosed with a serious medical condition is not a qualifying life event. That’s why it’s important to get your coverage during open enrollment or when you do experience a qualifying life event. You don’t want to be caught without coverage when you really need it.

Likewise, becoming pregnant is not a qualifying life event, though having a baby is. That means that if you are uninsured when you discover you’re pregnant, your maternity care may not be covered. Though you will be able to enroll yourself and your baby in an Obamacare plan after the child is born, your new coverage will not pay for past medical claims.

It’s also important to note that while all Obamacare-compliant plans cover the same suite of 10 essential health benefits, some services can be denied if the insurance company providing your health coverage deems that the service is not medically necessary or if the service is not performed by an in-network doctor. Check with your insurance company or your licensed agent to learn more about your coverage.

Health Insurance Coverage Under Obamacare Summary

The Affordable Care Act (Obamacare) makes health coverage available and more affordable to many Americans. Prior to the Obamacare changes rolled out in 2014, people with pre-existing medical conditions could be denied health coverage, or charged more than their peers without pre-existing medical conditions. Since 2014, you no longer be denied health coverage under Obamacare due to a pre-existing medical condition, and you cannot be charged higher premiums due to a pre-existing medical condition. To get health coverage under Obamacare, you can enroll during the annual Obamacare open enrollment period or during a personal special enrollment period if you have a qualifying life event.