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Obamacare and Coverage of Pre-existing Medical Conditions

If you’ve followed the media coverage of Obamacare since it was first signed into law back in 2010, then you know just how controversial of a topic this can be. Over the years, polls have shown a great divide in terms of how Americans feel about Obamacare.

Today, polls show that the public is pretty evenly split on the subject, but there’s one aspect of Obamacare that most people seem to agree has been beneficial to all: changes prohibiting insurance companies from declining coverage to people with pre-existing medical conditions.

This article will review the history of coverage for pre-existing medical conditions and provide you with some important information about getting covered today.

Pre-existing conditions before Obamacare

Prior to the implementation of Obamacare, insurance companies were under no obligation to provide coverage to people with pre-existing health conditions. This meant that a person could be turned down for health coverage if he or she had what was considered to be a pre-existing condition. Unless you’re very young, you likely remember a time when this was common. A pre-existing condition is a medical problem that existed prior to a person’s enrollment date in a health insurance program.

Common pre-existing conditions before Obamacare

Some of the more common pre-existing conditions that could lead to refused coverage included:

  • heart disease
  • arthritis
  • cancer
  • diabetes
  • asthma

Even pregnancy was considered a pre-existing medical condition, which meant that if you became pregnant without insurance, your application for coverage could very well be denied because of your pregnancy. In fact, it wasn’t uncommon for insurance companies to even decline applicants for coverage as a result of medical conditions they had in the past that had been successfully treated or cured years prior.

Few exceptions on pre-existing conditions before Obamacare

In the old days, there were just a few exceptions to these rules on pre-existing medical conditions. For example, employer-based group health insurance plans could not decline applicants based on pre-existing medical conditions, and a new baby, or a new adult added to an existing plan through marriage, could not be declined due to pre-existing conditions.

It’s also worth noting that a few states (but just a few!) had passed laws of their own that prohibited insurance companies from declining people based on their health history and any pre-existing conditions.

Challenges for people with pre-existing conditions

Still, in the majority of cases, if you had a pre-existing medical condition and were uninsured, you could have a very difficult time finding coverage. Even if you lost coverage through your employer and had a pre-existing condition, you could be reduced to paying for COBRA coverage in order to retain your health insurance. COBRA is an option that allows you to continue your old employer’s plan, but at your own expense—which often meant spending hundreds of dollars a month out of pocket for coverage.

The results of all this was that the people who needed health coverage the most were often the same people who had the hardest time getting approved for coverage, even if they could afford it. And even if a person with a pre-existing condition was approved, they could end up paying significantly more per month as a result of their medical history.

Pre-Existing condition coverage under Obamacare

When major changes brought on by Obamacare were first implemented in 2014, health insurance companies were no longer allowed to deny applicants coverage based on pre-existing medical conditions. Furthermore, Obamacare prohibited insurance companies from charging people more for coverage based on their medical history or the mere presence of pre-existing conditions.

It’s worth noting, however, that there is one exception to this rule: in most states, if you’re a smoker, you can still be charged more for coverage. However, you can no longer be denied coverage due to the presence of pre-existing medical conditions alone.

Changing health insurance as we know it

This revolution in the law changed the world of health insurance as we knew it in the United States. As a result, when open enrollment for 2014 Obamacare plans began, a huge rush of people who had never been able to secure coverage on their own as a result of their medical history (many of them older Americans) were finally able to get the coverage that they needed.

Prior to the implementation of Obamacare, pre-existing condition denials in health insurance were on a steady rise. In fact, an estimated 172,400 people were denied insurance coverage due to pre-existing conditions in 2007—and that number grew to nearly 258,000 by 2009. Thanks to Obamacare, those quarter of a million people who were denied coverage in 2009 are now able to obtain health insurance despite their pre-existing conditions. Millions more Americans could be left uninsured today if it weren’t for this change in law.

Buying Obamacare insurance with pre-existing condition

If you have a pre-existing condition or even had a condition in the past that has since been treated or cured, this change in the coverage of individuals with pre-existing conditions certainly benefits you. No longer will you be denied coverage because of your medical history, nor will you have to worry about paying a higher premium. However, if you don’t have health insurance coverage currently, there are still some things you need to know to make sure you don’t end up in a problematic situation down the road.

Don’t wait until you get sick to buy insurance coverage

One of the biggest mistakes people make when it comes to Obamacare is thinking that they can wait until they get sick or need some kind of medical procedure done to apply for health insurance. After all, you can’t be denied for an existing condition, so why bother paying for insurance if you’re perfectly healthy right now?

First of all, keep in mind that you may only be able to sign up for Obamacare at a specific time during the year known as open enrollment. This period typically occurs towards the end of the year and lasts around three months.

Outside of Obamacare’s nationwide open enrollment period you need to experience a qualifying life event in order to purchase coverage. For example, if you experience the birth or adoption of a new child, this is considered and life-qualifying event and you will typically have sixty days in order to change your coverage or sign up for a new plan. Other qualifying life events include marriage, divorce, and loss of employer-based coverage.

Even with a qualifying life event, it’s worth remembering that you have just 60 days to enroll. If you wait beyond that time, you may have to wait until the annual open-enrollment period.

Pregnancy isn’t a qualifying life event

Becoming pregnant while uninsured is not a qualifying event under Obamacare, so (unless you experience an actual qualifying life event) you cannot enroll in coverage unless it’s open enrollment season. In other words, if you get pregnant while you’re uninsured, you could very well end up paying for your maternity care out of your own pocket.

Your best bet for avoiding a situation where you’re stuck without coverage is simply to apply for coverage as soon as possible during the next open-enrollment period or upon a qualifying life event. By getting covered now, not only will you be able to enjoy added peace of mind in knowing you’re insured, but you can also avoid potentially costly fees and penalties for not having health insurance when it comes time to file your taxes.

The Bottom line on Pre-existing Condition & Obamacare

While it may be true that Obamacare isn’t perfect in all regards and there are still some important things to remember when it comes to obtaining coverage with a pre-existing condition, aren’t you glad the “old days” of health insurance are over with, and that no one you love has to worry about being declined health insurance simply because they need it?