Question 1 – Can’t I still get “regular” Health Insurance?
A few months ago, the entire world of American health insurance was turned inside out. The PPACA (the Patient Protection Affordable Care Act) commonly referred to as “Obamacare” went into force, and in the wake of its rollout I’ve been seeing some very common questions cropping up. I’ll address some of the most commonly asked right here.
*Please note this is a blog of opinion and not meant to incite political debate. Information shared here is meant to be general in nature and accurate at the time of publication. Please contact us for information specific to your situation and more current details, as the laws have been changing on a near daily basis.
1. Can’t I still get “regular” health insurance?
Well, that kind of depends on how you define “regular” health insurance.
Health insurance used to be available for purchase year round, and in order to apply one would submit an application to the health insurance company which involved questions pertaining to medical history and lifestyle. These questions would vary from company to company.
After submission, the application would go to an Underwriter – someone who would assess the medical history and determine how much risk the company would be taking on by accepting that client. Based on their assessment, the applicant would either be accepted or denied, or sometimes accepted but with either an exclusion placed on a health condition, or the premium rate increased accordingly. These are known as “pre-existing conditions” – a health condition you currently have or for which you’ve recently been treated.
- For example: let’s say two 35 year old men apply for the same policy. One of them is in excellent health, the other has high blood pressure (controlled, 1 medication), asthma (no hospitalizations, just an inhaler as needed), is moderately overweight and uses tobacco. The first man would likely be accepted at a preferred rate, the second would likely receive a rate increase – although none of his conditions are severe, he is at risk for developing type II diabetes, COPD, or emphysema. If he were to discontinue tobacco use, lose weight, or have one of his other conditions clear up he would later be able to apply for a re-rate: asking the underwriter for a re-assesment due to his improved health.
So, they’d both be able to get a health insurance plan, but they’d pay according for their estimated risk to the company. Now, let’s say one of them was just told he needed surgery – let’s say he’d just torn his ACL and needed that repaired. The health insurance company would have denied his application – they couldn’t afford to take on someone knowing they’d have thousands of dollars in medical claims coming in right away. This is why it was critical to have health insurance at all times – one couldn’t wait until they had an injury or condition and then apply without risk of rate increase or denial.
So, with the ACA all that changed – health insurance companies are no longer allowed to increase premiums or deny health insurance applications based on pre-existing conditions. The ACA also set limits on how premiums could be determined (for example, gender no longer makes a difference) and standardized the benefits for health insurance plans (the 10 essential health benefits are now mandatory for all ACA-qualified health plans – which includes maternity coverage).
The trade off for having all health plans being guaranteed issue with no medical underwriting was the need to create “election periods” – certain times during the year where one may join or switch plans. The reason for this is something called “adverse selection” – if you knew you could wait until you got sick or injured, buy insurance right then, and have your condition covered; well then why carry health insurance at all? Health insurance works a lot like a bank – they have to pool everyone’s money together in order to pay claims. You may have plenty of years where you pay more in premiums than they pay in claims, but then you may have a medical emergency that more than makes up for the premiums you’ve spent. By enforcing these election periods, the companies are protected from that level of risk – people can only buy during the open enrollment period (the next one is currently scheduled for Nov. 15th 2014 – Feb. 15th 2015) or during certain special qualifying events, like moving, marriage, loss of other ACA-qualified health coverage, birth/adoption of a child, etc.).
So, back to the point – if you define “regular” health insurance as insurance as it worked before, then no – you cannot get “regular” health insurance any more. You can if you have a qualifying event, during the next open enrollment period.
HOWEVER: There are other non-ACA qualified plans that ARE available year round. The most popular of the non-ACA plans are Short Term health insurance plans. These do not cover pre-existing conditions and do not count as ACA qualified coverage, but are available with some simple medical underwriting and often for significantly lower prices.
The ACA also included expansion of Medicaid programs and one may qualify based on income even if previously ineligible. Medicaid and other government based health care plans (such as VA benefits, Medicare, Tricare, and others) are generally considered ACA qualified coverage.
So, I hope that answers that question. Please contact us for quotes, questions, or anything else we can do for you – Get a Free Quote Now!