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Health Care Reform:

Health Insurance & Affordable Care Act

Health Care Reform and Pre-Existing Conditions: FAQ

Answers to WebMD readers' questions about health care reform and pre-existing conditions.

WebMD Feature

Under the Affordable Care Act, people with pre-existing health conditions cannot be denied health insurance as of 2014, when the law takes full effect.

WebMD readers submitted a number of questions about this aspect of the law. Here are answers.

Q: Will there be a limit as to how high a premium insurance companies can charge if you have a pre-existing condition?

A: Yes. As of 2014, insurers cannot charge consumers different rates for health insurance because of health status or gender.

You can be charged more for your age, however, with older people paying a higher premium than young people. But that increased charge is capped at no more than three times the standard rate.

Q: I am a 44-year-old with Stage IV Lung Cancer. I would like to have comfort in knowing that I don't have to worry about having a restriction on my lifetime benefit. Right now there is none, due to Health Care Reform, but what if they decide to get rid of it?

A: That’s not likely to happen.

For health plans beginning after Sept. 23, 2010, insurance companies can no longer impose lifetime limits on benefits. That’s a big deal for people with serious illnesses, such as lung cancer, or other chronic conditions requiring ongoing and/or very expensive care.

Since the Affordable Care Act was passed in March 2010, many threats to repeal the law have been made. In fact, in January 2011, the House of Representatives did vote to repeal the Affordable Care Act, a measure that was rejected by the Senate. That means that the benefits gained thus far under the law are still in place.

Although lawmakers can hold up money to fund aspects of the law that have yet to be implemented, repealing the law as a whole or even specific consumer protections (such as no lifetime limits for care) is not likely.

Q: Will the definition of pre-existing conditions change by 2014, when the Affordable Care Act goes into full effect?

A: A pre-existing condition is generally considered an illness or disability a person has prior to applying for health insurance coverage. Currently, the definition varies among states and even by insurance plans.

However, once the law takes full effect in 2014, that definition will lose its importance. Under the law, no one can be denied health care insurance for any reason, including an existing medical condition.

Q: What if I'm healthy but risky? If you're fine now but you have certain risks you can't change, can you be denied coverage?

A: As it stands now, if you apply for insurance on the private market (as opposed to getting it through your job), insurance companies will look into your medical history and can deny you coverage based on what they find, including perceived health risks.

As mentioned above, effective in 2014, insurers will no longer be able to deny anyone on the basis of their medical history.

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