Health Care Reform and Your Pre Existing Condition

It is no secret that pre existing conditions account for a large number of uninsured Americans. These are individuals who can not obtain affordable health insurance due to some type of health related problem. Health conditions such as high blood pressure, high cholesterol, diabetes, cancer, obesity, heart attack and stroke, are just a few. It’s so sad but a family can be financially destroyed by a medical emergency unless they have quality health insurance.

All that is about to change with the passage of the new Patient Protection and Affordable Care Act. One of its major components is the elimination of the pre existing condition requirements currently imposed by health plans.

Children will be the first to gain affordable coverage. Starting in September 2010, insurers will no longer be able to exclude children from being on a family policy because of a pre existing condition. This applies to new policies and for families who already have a health insurance policy.

So much for the good news. Looks like adults will have to wait until 2014 for their health coverage to honor the new exclusion protection granted to children. However, there is one ray of hope. 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”.

This is how “Plan B” is suppose to work.

Currently approximately 35 states have high-risk pools, some of whom may still be open for new enrollees. Check with your state insurance agency to see if your state currently has such a pool. But remember, these existing pools are not the insurance pools that will be established under the new law as “Plan B”. States are being asked if they want to start or continue providing a risk pool for their state. If your state does not currently have or does not plan to set up a high-risk pool… no problem. The Department of Health and Human Services will establish and administer a pool for your state.

So starting in mid-year 2010, this temporary backup plan will be established for those uninsured individuals who have existing health problems (particularly individuals who do not have a risk pool in their state or who could not obtain coverage in their state pool). This new plan will be created as a short-term, national high-risk insurance pool. Any US citizens or legal immigrants with health problems and who has been uninsured for at least six months will be eligible to enroll into this high-risk pool.

This federal health insurance pool will be significantly more affordable than currently state run high-risk pools; however, some individuals may still have premiums of up to 125% of the health insurance cost for a healthy individual. Per year, the maximum out-of-pocket cost sharing for enrollees should be no more than $5,950 for individuals or $11,900 for a family. Premium subsidy assistance may be available.

This federal health insurance pool will continue through 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.

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