Short Term Health Insurance Pre Existing Conditions – As attention turns again to the possibility of repealing the Affordable Care Act (ACA), millions of people with pre-existing conditions have reason to be concerned. Among many other provisions, the ACA banned discrimination in private health insurance based on health status—insurers are prohibited from turning people away, charging them more, or changing coverage to exclude their pre-existing conditions.
What are pre-existing conditions and who has them? As most simply defined, a pre-existing condition is any health condition that a person has before enrolling in health coverage. A pre-existing condition might be known to the person – for example, if they know they are already pregnant. People can also apply for cover when they unknowingly have an undiagnosed condition – for example, tumor cells could be growing inside but won’t be diagnosed until months or years later. A pre-existing condition may be mild – for example, seasonal allergies or acne treated with simple medications. Or it could be more serious or require more expensive treatment – such as diabetes, heart disease or cancer.
Short Term Health Insurance Pre Existing Conditions
Estimated that in 2018, approximately 54 million US non-elderly adults (27%) had “declining” pre-existing conditions that would have made them “uninsurable” in the pre-ACA individual health insurance market. Excludable conditions were identified through an analysis of health insurance underwriting manuals. Insurers kept lists of health conditions for which applicants would be denied coverage. Disclaimable conditions include AIDS/HIV, congestive heart failure, diabetes, epilepsy, severe obesity, pregnancy and severe mental disorders. Obviously, not all of these 54 million adults now buy individual health insurance. But the individual market is where people go when they’re between jobs that offer health benefits and aren’t eligible for coverage from a public plan like Medicare or Medicaid. If health coverage were to revert — as it was before the ACA in most states — those 54 million adults could be uninsurable if they were laid off from their jobs and lost their place-based health benefits for work.
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Other estimates put the number of non-elderly adults with pre-existing conditions at 102 million, 122 million or 133 million. In addition to opt-out conditions, these estimates took into account conditions that would not necessarily cause a person to be denied when applying for individual health insurance, but could trigger other adverse actions. Hypertension (high blood pressure) is one such common pre-existing condition that affects more than 33 million adults under the age of 65. A study of medical underwriting practices asked individual market insurers to consider a hypothetical applicant with high blood pressure who smoked and was overweight. In 60 applications for coverage, this person was rejected 33 times (55%); offered a policy with overcharged premiums 25 times (42%) and offered cover without restrictions or surcharges twice (3%). The U.S. Department of Health and Human Services (DHHS) has released a final rule that will undermine high-quality, comprehensive coverage for adults, children, and especially people with pre-existing conditions. The Short Term Limited Duration (STLD) final rule relaxes requirements for insurance plans that may discriminate against people with pre-existing conditions, must not cover essential benefits, do not cover out-of-hospital prescription drugs, and otherwise , leave people unprotected from health and financial damage. Nevada Revised Statutes limit STLD plans to 185 days.
It’s more important than ever for consumers to carefully compare health insurance options to make sure the plan they select won’t leave them in the lurch if they have an unexpected medical event. Often these STLD plans are marketed as comprehensive health insurance, but they are NOT comprehensive. While some people may find that STLD plans offer lower premiums, they offer much less coverage in return; which could mean higher costs in the end if a consumer gets sick or needs certain types of medical care. The DHHS rule allows plans to deny coverage or charge higher premiums because of pre-existing conditions, age or gender. These plans may also drop consumers from their coverage if they are diagnosed with a medical condition after enrollment. Without the protections offered in Nevada Health Link qualified health plans, consumers purchasing STLD plans may think they have coverage but with few benefits. The following is a list of benefits NOT covered by STLD plans:
When choosing health insurance, always consult a navigator, certified enrollment assistant, or licensed broker through Nevada Health Link. Use our personal assistance tool to find a trained and certified person in your area who can help you with the one-on-one application process. If you miss open enrollment, you still have options. Certain qualifying life events (QLEs) may make you eligible for a special enrollment period. QLEs are life-changing events such as job loss, change in income, marriage/divorce, and the birth/adoption of a child, to name a few.
Email us at customerserviceNVHL@exchange.nv.gov for any additional questions you may have about Nevada health insurance plans and the special enrollment period to see if you’re eligible today.
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Recent federal regulations related to short-term health insurance (STLDI, or “short-term” plans) have expanded the types of health coverage options available in today’s market. Having options helps employers and individuals tailor coverage to their specific needs. Making the right choice, however, can be complicated because coverage varies widely between different types of plans. It’s important to understand not only what the monthly premium will be, but also what the insurance plan covers – and doesn’t cover. This article provides a brief guide to help employers and employees navigate some common health plan options.
Affordable Care Act plans offer comprehensive major health coverage. These plans are intended to serve as an individual’s primary health coverage and must meet a variety of federal standards designed to ensure both access to coverage and quality of coverage. ACA-compliant insurance products are available in the individual, small group, and large group markets. Lower-income people who purchase individual ACA coverage through a federal or state marketplace (exchange) may be eligible for a premium tax credit to help pay the premium for the coverage.
Until January 1, 2019, people who do not have health coverage under the ACA may have to pay a federal tax penalty.
Pre Existing Condition Coverage
Short term insurance plans are individual market products. As the name suggests, STLDI plans are designed for people who are transitioning from one type of primary health coverage to another and have a temporary gap in coverage. Due to the short-term nature of these plans, they are not subject to the requirements of the ACA. Historically, short-term coverage has generally been limited to a total coverage period of less than 12 months. New federal regulations issued in August 2018, however, allow short-term plans to continue for a total coverage period (including any renewals) of 36 months.
STLDI is generally considered a type of major health coverage because people who have such coverage typically rely on it as their primary health insurance. However, because short-term plans are not subject to ACA requirements, this coverage is very different from ACA-compliant coverage, and people considering short-term coverage should be aware of the difference.
Short-term coverage may be useful in some situations (for example, for people who are only looking for coverage until the next open ACA enrollment period). Because short-term coverage is less comprehensive than ACA-compliant coverage, it can also be much cheaper, especially for healthy people.
Short-term coverage is not the same as COBRA continuation coverage, which may be available when an employee or covered family member loses employer group health coverage (for example, upon termination of employment or divorce). COBRA coverage is major health coverage under the ACA.
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The analysis examines 24 distinct short-term insurance products currently marketed in 45 states and the District of Columbia through eHealth or Agile Health Insurance.
The federal extension of short-term coverage to 36 months (including renewals) has been welcomed by some, but has also created controversy and concern about the potential impact on covered individuals and the individual insurance market as a whole. States may impose additional restrictions on short-term coverage (for example, limiting the period of coverage or imposing benefit mandates). Thus, the scope of short-term coverage may vary from state to state, and the full impact of the new rules on the market may not be clear for some time.
Supplemental insurance policies are designed to provide an additional level of financial protection in the event of an accident or illness. These types of policies are different from ACA-compliant plans and STLDIs because they are not intended to serve as primary health coverage or as a substitute for such coverage. For this reason, federal and state law have long recognized these plans as
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