Pre-Existing Conditions

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cmonkey
Posts: 1814
Joined: Mon Apr 21, 2014 11:56 am

Pre-Existing Conditions

Post by cmonkey »

So I believe Obamacare made it so insurance companies cannot deny you coverage if you have a pre-existing condition, purchase their insurance and then expect coverage.

How about switching policies within the same company during the normal course of business (annual change)?

Long story short, I get to have minor surgery, however, I'm on the "cheap" plan. I'm planning to switch to the "not cheap" plan next June for other reasons, but wonder if I'd be denied coverage for the surgery since I know about it now. It would be far more financially advantageous to have the surgery done next June as opposed to now.

Tyler9000
Posts: 1758
Joined: Fri Jun 01, 2012 11:45 pm

Re: Pre-Existing Conditions

Post by Tyler9000 »

I'm not a health insurance expert, but under current law I believe the pre-existing condition coverage requirement is universal and includes changes of plans with the same carrier provided you enroll in the appropriate window.

Scott 2
Posts: 2824
Joined: Sun Feb 12, 2012 10:34 pm

Re: Pre-Existing Conditions

Post by Scott 2 »

How are you planning to change coverage in June, outside of the open enrollment period for 2018? My understanding is part of what makes the math work for the affordable care act, is that you cannot do so, unless you have a qualifying life event.

When I've looked, over the course of a year, the price for consuming your full deductible + premium for the year, tends to be more or less equal across the various coverage levels. With major surgery, you don't come out too far behind on even a high deductible health plan, due to the dollars saved on premiums, especially if you are using an HSA as a tax shelter. Assuming you stay in network for everything, of course.

bryan
Posts: 1061
Joined: Sat Nov 29, 2014 2:01 am
Location: mostly Bay Area

Re: Pre-Existing Conditions

Post by bryan »

It may be that @cmonkey's company annual enrollment happens in ~June. Or if he's not employed and buys insurance himself, I think you can change your insurance whenever you want (it just won't be a plan that is usually offered during open enrollment, probably).

I know you can't be denied when buying a policy, but not sure how the non-exchange insurance policies are allowed to set premiums on a case-by-case basis or if they can say "hey, we're not paying for this since we both learned about it 6 months ago and you opted for no treatment at that time."

cmonkey
Posts: 1814
Joined: Mon Apr 21, 2014 11:56 am

Re: Pre-Existing Conditions

Post by cmonkey »

My open enrollment is in June and there will likely be a baby after June as well, so I'd like to have those all on one year. Without children, the cost of our best plan is actually half the price of the deductible of our cheapest plan which is why I'd like to wait until June to do this. Once we had the baby, that's a qualifying life event so I could switch back to a cheaper plan if I wanted.

Scott 2
Posts: 2824
Joined: Sun Feb 12, 2012 10:34 pm

Re: Pre-Existing Conditions

Post by Scott 2 »

Ok, didn't realize your enrollment schedule was mid year. I assume this is group insurance through your employer. Could you ask HR or their broker?

I don't know enough to give you a certain answer about how the surgery would be handled. Maybe someone else on the board does?

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