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Health Care Reform:

Health Insurance & Affordable Care Act

Buying Insurance & Pre-Existing Conditions: FAQ

Having a health condition such as diabetes, high blood pressure, cancer, or depression used to be a problem if you were shopping for health insurance.

That's all changing with health care reform.

Starting in 2014, health insurance companies won't be able to turn you down or charge you more for health insurance just because you have a medical condition. They also can’t make you wait before getting or continuing treatment, and they can't drop your coverage.

These protections all come from the Affordable Care Act.

How do I know if I have a pre-existing condition?

Pre-existing conditions are health problems you already have at the time you apply for health insurance. They can include:

  • Life-threatening illnesses such as cancer
  • Chronic conditions such as asthma, depression, diabetes, and heart disease
  • Short-term things, like back injuries or pregnancy

Will health care reform laws make it easier to include a child with an ongoing health problem on my insurance plan?

Yes. As part of the Affordable Care Act, since September 2010, insurers are no longer allowed to deny health coverage to children younger than 19 because of a pre-existing condition.

Will needing insurance coverage for a pre-existing condition make me have to pay higher premiums?

Starting in 2014, health plans can no longer use pre-existing conditions as a reason to charge you more each month for your premium.

Health plans will be allowed to adjust premiums based only on:

  • Whether you have an individual or family plan
  • Where you live, since medical costs are higher in some areas than others
  • Your age
  • Your current and past use of cigarettes or any other tobacco product

What should I consider when shopping for a plan if I have a chronic condition?

  • Drugs: Check your plan’s drug formulary, a list of prescription medicines a health plan covers, to anticipate your drug costs.
  • Self management: These programs are covered under plans bought through the Affordable Care Act Marketplaces.
  • Doctor visits: Consider how often you’ll need to visit the doctor, including any specialists, for your condition. Make sure they are in your network to avoid higher out-of-pocket costs.

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