Some say the new healthcare reform bill will provide health coverage to those with pre existing conditions. Can this be? We all know that many American are uninsurable due to pre-existing conditions but will healthcare reform really help these individuals. If so, the new healthcare reform bill should be a welcome relief.
So getting health insurance is hard for individuals who suffer from a serious health condition. Having major health conditions such as diabetes, cancer, heart attack or stroke are not the only conditions that will raise a red flag on getting coverage. Minor conditions such as high blood pressure, high cholesterol or even obesity can present higher premiums or complete policy denial.
It looks like all that is about to change with the passage of the new Patient Protection and Affordable Care Act. The main element is the elimination of the pre existing condition requirement that is imposed by those seeking health insurance.
The rollout of coverage for those with pre-existing conditions will start with our children. Insurers can no longer exclude children with pre existing conditions from being on a family policy. This should be effective in late September of 2010. The new rules apply to newly written policies and for families who already have a health insurance policy.
Now let’s take a look at what’s in store for the adult population.
Adults must wait until 2014 to begin their health coverage for this same exclusion protection given to children. But there is one glitter of hope. For the next 3 1/2 years, adults with pre-existing conditions can find some relief in a newly planned federal backup plan entitled 'Plan B". It will work like this.
Currently, some states operate a regulated high-risk pool for those individuals with pre-existing conditions. Checking with your insurance department will determine if such a pool exists in your state. Do understand… these existing pools are not the insurance pools that will be established under the new healthcare reform.
First, states were asked if they wanted to start or continue providing a risk pool for their respective states. Then based on how your state responded to that question will determine if a new federal high-risk pool will need to be established or if your state will continue with it’s existing high-risk pool.
In mid-year 2010, this temporary backup plan will start for those uninsured individuals who have existing health problems (especially those individuals who did not have a risk pool in their state or could not obtain coverage in their state pool). The new plan will be a short-term, federal high-risk insurance pool. If you are a US citizen or legal immigrant, you will be eligible to participate in this high-risk pool as long as you have serious health problems and have been uninsured for at least six months.
This new federal high-risk pool will have much lower premiums compared to the current state run pools; however, there will still be individuals paying up to 25% more than if they were healthy. The maximum out-of-pocket yearly cost sharing for enrollees should be no more than $5,950 for individuals or $11,900 for a family. It has been noted that some form of premium subsidy assistance will be available.
This federal health insurance pool will continue through 2013, then beginning in 2014, insurers will not be allowed to deny any applicants because of their preexisting conditions.
So for those with a pre existing condition, this new healthcare reform bill should be a welcome relief and bring about major changes in the way insurers provide health care services.
