"All I want to know is, how soon until we can apply for the new government insurance that doesn't allow them to refuse you for a pre-existing condition?" a friend asked me the other day. Her husband, who's in his late 50s, has been diagnosed with precancerous colon polyps that need to be removed. He had been on COBRA after being laid off from a financial services job two years ago -- and it just ran out.
One area of the new health care bill that's not controversial -- at least not to those who've been denied health insurance because of a pre-existing condition -- is the section that says insurers can no longer decline someone from coverage just because they're not in perfect health.
There's been so much arguing back and forth about what the bill does and doesn't promise that I thought we should take a close look at this particular issue, which affects so many Caring.com members. Those of us caring for family members with health problems are right in the line of fire on this issue.
Here are answers to the most common questions Caring.com members are asking.
Q. Does H.R. 3590 - the Patient Protection and Affordable Care Act -- prohibit insurance companies from refusing coverage for those with pre-existing conditions?
A. Yes, it does.
Q. How soon does it go into effect?
A. Officially, six months from the day the bill was signed into law; September 23rd is the date that's most commonly mentioned. But the high-risk pool insurance, the first step for those with pre-existing conditions, will become available 90 days from the date of signing. Practically speaking, that means early June.
Q. Does this mean in 90 days I can apply for insurance and they have to give it to me despite my condition?
A. Yes, though you may pay more for it. What's happening is that the health care reform bill sets up a two-step process for those with pre-existing conditions.
The rollout of full, affordable coverage for those with pre-existing conditions starts with children. Starting Sept. 23rd insurers won't be able to exclude children with pre-existing conditions from being on a family policy. This applies to families who already have a policy, as well; starting this fall, your child with a pre-existing condition will be covered under your family policy.
For adults, though, this complete protection doesn't start until January 1st, 2014. At that point, adults will be protected from coverage exclusions just like children.
For the next three years and eight months, those with pre-existing conditions will be relying on what some folks are calling "Plan B", the interim solution. Here's how it's going to work.
It's a short-term, national high-risk insurance pool. American citizens and legal immigrants who have preexisting conditions and have been uninsured for at least six months will be eligible to enroll in this pool and receive subsidies to help them afford the premiums.
Under the law, the premiums for this pool will be the same as would be charged for a standard population of people with varying risks. Maximum out-of-pocket cost sharing for enrollees will be $5,950 for individuals and $11,900 for families, per year.
Q. Who do I talk to about applying?
A. Check with your state department of health to find out if your state is setting up a pool. States have 90 days from the March 23 signing of the health reform bill to set up a program to cover people with pre-existing conditions who have been uninsured for at least six months. If a state can't or won't comply, the Department of Health and Human Services will administer one for them.
Q. If my state is not setting up a high-risk pool, what should I do? A. You probably won't know that yet; each state has until April 30th to decide if it's going to set up its own high risk pool. Some states already have high-risk insurance pools that operate under a different set of rules, and those states have to decide if they're going to switch those plans over to abide by the new Federal rules. A recent study conducted by the Kaiser Family Foundation concluded that 35 states have high-risk pools with enrollment totaling 200,000 people; states with the largest enrollment include Illinois, Maryland, Minnesota, Oregon, Texas, and Wisconsin. This link shows which states currently have high-risk pools and whether they're currently open to new enrollees. But remember, these are not the insurance pools that will be established under the new law; those don't start until early June. And don't worry; if your state is not listed here or doesn't set up a high-risk pool, the Department of Health and Human Services will be administering a pool for your state.
Q. What do I do if I lost my health insurance less than six months ago?
A. If you're like my friend whose husband's COBRA coverage just ran out, unfortunately you'll have to wait out the six-month window before you qualify for the high-risk pool coverage. However, what's different is that you don't have to try to hide a pre-existing condition, worrying that it will prevent you from obtaining coverage.
What this means is that you shouldn't wait to have any health problems treated. (I advised my friend that her husband shouldn't risk waiting to have his polyps removed.) During the next few months, utilize your local public hospitals and clinics to obtain health care for the conditions you have that require treatment. Then as soon as you're eligible to join the high-risk pool, apply.
i thnk it was helpul for us n get benifit
There are states that already have state-run High Risk Pools. For example, Mississippi's HRP will accept you immediately after COBRA runs out, or if you lost your individual insurance for reasons other than nonl-payment of premiums.
I have been insured thru the Oregon Medical Ins. Pool and paying a premium of about $475. per month. I am insured as an individual. I just got a notice that they are raising my rate to $546. per month. that is: $6552. per year. your web site quotes: Under the law, the premiums for this pool will be the same as would be charged for a standard population of people with varying risks. Maximum out-of-pocket cost sharing for enrollees will be $5,950 for individuals and $11,900 for families, per year. Is the Oregon program wrong? How does a working guy afford such a hugh amount for insurance? The whole system stinks!
I think it was very helpful
The dates of available eligible enrollment. The heads up about the costs. The age ranges.
My wife has just been turned down for health insurance because of a pre-existing condition ( 9-07-2010 ) Do we have to wait until 2012 until this pre-existing or 2014? Seens to me this insurance that Obama and the congress and senate is one big joke. Can not see why pre-existing conditions didn't start now when they passed the ins. plan. Just another ripeoff to the citizens that pay their salary. They do not think of us because they have their on plan ,but they should have the same plan that all the people are on.
Now the insurfance co cant drop us if our health is caused by a terrorist attack
Anything is possible when funded by the tax dollars of hard working Americans. It's statistics plain and simple. Those of us who have been paying by the rules all our lives, paying premiums, paying taxes, going to work each day, not overusing the system will shoulder the inevitable burden in the form of reduced quality of care, higher taxes and higher premiums. Are there people who have also been playing by the rules who have been caught up by misfortune and pre-existing conditions and general hard times? Of course, but that is not be the large majority we are being asked to subsidize. The real issues such as pre existing conditions massive malpractice abuse and the prohibitive cost of bringing new medical innovations to the public could have been solved by taking a laser approach not the shotgun approach that was politically motivated by those in Washington. Or at least we could have tried to fix what is arguably one of the best medical systems on the planet before scrapping it for political gain.
Melanie - I hoped that was what you meant! If anyone complains or is surprised when insurance companies increase their rates to ALL of us in light of their soon-to-be new requirements, please remember that insurance companies are not charities! They do their best to understand the odds of premiums versus payouts and hope to strike a balance between what their customers will pay and what it they eventually require to pay back to their customers. At the end of the day, the insurance companies, like all businesses in the private sector, hope to make a profit on the transactions. If they do not, they go out of business and their services need to be provided by other entities. If these other entities end up playing with "house money" (tax-payer money!) then services rendered can be customized to fit monies available. Read into that scenario what you will!
Dear John, I'm sorry if I wasn't clear. What I mean is that, because the high risk pools can no longer refuse to accept you with a pre-existing condition, it's not necessary to hold off on getting treatment when you need it because you're trying to apply for insurance, a situation which has been common in the past.
I began to wonder today, what about Long Term Care Insurance do the new laws effect that type of insurance. I have a friend who is diabetic who can not get Long Term Care Insurance because of her pre-existing condition. It also appears to me that the insurance companies are still going to up their rates.
"However, what's different is that you don't have to try to hide a pre-existing condition, worrying that it will prevent you from obtaining coverage." ?