Pre Existing Condition Health Insurance

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According to the new healthcare reform bill, insurers must cover pre-existing conditions. Will it really happen as they stated?

Many Americans have health-related problems. Insurance companies define this as a pre existing condition. A pre-existing condition is a health problem which existed before you applied for a health insurance policy or enrolled into a health plan. Health related problems keep these individuals from getting healthcare coverage. A pre-existing condition can be something as common as obesity or as serious as heart disease, cancer or diabetes. Many families have seen their financially future destroyed without having access to quality health insurance.

With passage of the new Patient Protection and Affordable Care Act, changes are starting to happen. The current method of denial of coverage for a pre existing condition will be eliminated.

The rollout of coverage starts with children. Effective in September 2010, children who have a pre existing condition can not be denied access to their parents’ health plan. Also, the insurance companies will no longer be allowed to insure a child, yet exclude treatments for that child’s pre-existing condition. New family policies and policies of families who already have a health insurance policy will be able to benefit from this new rule.

Adults will have to wait until 2014 to get this same exclusion protection granted to children. However, there is something in the mean time. For the next 3 1/2 years, those adults with pre-existing conditions can find some relief in a new federal backup plan entitled ‘Plan B”.

It should work like this.

Right now over 30 states operate a high-risk pool for those with serious health conditions. Many of these states still have open enrollment. Your state insurance agency will know if your state has such a pool. But these existing high-risk pools are not the same insurance pools as established under “Plan B”. Each state was asked if they wanted to start or continue providing a risk pool for their health challenged individuals. If your state doesn’t have or does not plan to start a high-risk pool… it’s really no problem. Based on the new healthcare reform bill, The Department of Health and Human Services will establish and administer a high-risk pool for your state.

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 were not able to obtain coverage in their state pool). This will be a short-term, national high-risk insurance pool. Those individuals with health problems and have been uninsured for at least six months will be eligible to enroll into this high-risk pool as long as they are a US citizen or a legal immigrant.

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 will be no more than $5,950 for individuals or $11,900 for a family. It’s been stated that some form of premium subsidy assistance will be available.

Coverage under the national high-risk insurance pools will be in place through the end of 2013. It will then be dissolved in 2014 when health insurance companies are required to offer health insurance coverage to everyone regardless of their health condition.

Based on items outlined above, the new healthcare reform bill can bring some major changes in the way insurance companies provide services for those with preexisting conditions.

Rudy Wilson is researcher and avid proponent of affordable health insurance. To learn more about affordable health insurance plans that Rudy recommends, visit now.

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