After the initial shock of learning that you have a chronic health condition wears off, your first question may be whether you can get health insurance with pre-existing conditions, and how much is this going to cost you?
Those are valid questions. With rising medical costs nationwide, more and more Americans are dealing with crushing medical debts. If you find yourself in this unfortunate position, here is what you need to know about health insurance with pre-existing conditions.
What Qualifies a Pre-Existing Condition for Health Insurers?
Most health insurance providers in Arizona define pre-existing conditions as any health issue you’ve been managing before your new health insurance policy begins. This could range from common ailments like high blood pressure, allergies, or tobacco use to more serious conditions like cancer, diabetes, or asthma.
Is Disclosing Your Pre-Existing Condition Mandatory When Applying for Health Insurance?
Yes, being upfront about any health conditions during your application process is crucial to your continued care. While you might worry about how this could affect your coverage or cost, concealing this information can lead to complications or denial of essential healthcare services when you need them, depending on your policy’s fine print.
How Much Will You Pay for Health Insurance With Pre-Existing Conditions?
The answer to whether or not you will face higher premiums or deductibles for health insurance with pre-existing conditions depends on how you applied for and received your policy.
Affordable Care Act Plans
Under the Affordable Care Act (ACA), health insurance companies cannot charge more, limit benefits, or deny you or a dependent coverage because of a pre-existing health condition. Five factors can affect your health insurance coverage costs:
- Your age: Older enrollees may face higher premiums.
- Your location: Costs can vary due to differences in state and local rules, competition, and cost of living.
- Tobacco usage: Insurers can charge more for people who smoke.
- Family size: Family plans may cost more than individual policies.
- Plan category: There are five tiers of plans—Bronze, Silver, Gold, Platinum, and Catastrophic—with varying premiums and out-of-pocket costs.
The ACA lists ten essential benefits that a comprehensive health insurance policy obtained through Arizona’s health insurance marketplace must cover:
- Ambulatory services
- Emergency services
- Hospitalization
- Maternity care
- Mental health care
- Prescription drugs
- Laboratory service
- Preventive and wellness services
- Pediatric services
- Rehabilitative and habilitative services and devices
One exception to the ACA’s coverage rule that ensures individuals and families can get health insurance with pre-existing conditions is “grandfathered” plans, which are health insurance policies purchased before Obamacare was implemented. These health plans are not required to protect pre-existing conditions or cover preventive care.
The ACA also prohibits AHCCCS and KidsFirst from charging more for or denying coverage because of a pre-existing condition.
You Might Like: What Options Are Available for Health Insurance for Low-Income Families in Arizona?
Employer-Sponsored Group Health Insurance Plans
If you are lucky enough to have an Arizona employer who provides group health insurance benefits, there is bad news and good news.
The bad news is that the policy may have an exclusion period. You cannot use any health insurance benefits to treat your pre-existing conditions during this period.
The good news is that federal law limits this exclusion period to no more than 12 months. After the exclusion period expires, the insurer cannot limit your access to any benefits under the plan, whether from a pre-existing condition or not.
Visit your plan administrator to learn whether your employer-sponsored group health insurance plan has an exclusion period for pre-existing conditions.
Health Insurance Plans Purchased Outside of Either the ACA or Employer-Sponsored Plans
There are times and circumstances when an ACA health insurance policy or the plan available to you through your employer does not give you the flexibility or affordability you need to manage your health.
If you find yourself in this position, rest assured that you can get health insurance with pre-existing conditions.
Short-term health insurance plans and those purchased outside of the are exempt from ACA’s rules. They can base eligibility and costs on medical history and tend to have blanket exclusions for anything related to a pre-existing condition.
Why a Health Insurance Broker Can Give You the Best Options for Health Insurance With Pre-Existing Conditions
Whether you have an ACA-governed health insurance policy or purchased one outside the market, working with an independent health insurance broker in your neighborhood is the key to getting the most comprehensive health insurance with pre-existing conditions at the best price.
Local Brokers Care
When you are dealing with a pre-existing condition, you may find yourself distracted and overwhelmed, and making informed decisions may be difficult. When you work with a local independent health insurance broker, you have the reassurance of talking to another person face-to-face or over the phone—no call centers, no lengthy dial prompts. You will be speaking with a professional in your community who is reliable, compassionate, and dedicated to getting you the best health insurance for your situation.
Related: Five Vital Questions to Ask During Your Free Consultation with a Health Insurance Broker
Local Brokers Know the Market
Choosing an independent health insurance broker in your community ensures that you are talking to someone who knows not only insurance but also their neighbors’ concerns—the hospitals they want to go to, the convenience of pharmacy locations, and the things that make them nervous about getting health insurance with pre-existing conditions.
Local Brokers Are Not Tied to One Insurer
One of the most significant advantages of using independent health insurance brokers is that they are not beholden to one insurance company. This means they can shop for the best health insurance with benefits for your pre-existing condition, whether an ACA plan or one outside the Marketplace.
Brokers can provide a personalized approach, helping you navigate the complex health insurance landscape, understand the fine print, and make the most of your coverage.
Don’t Let a Pre-Existing Condition Limit Your Healthcare Options
Are you researching options for health insurance with pre-existing conditions? Don’t limit yourself to sub-par insurance that does not provide the coverage you need at a price you can afford.
Arizona Health Insurance Experts is committed to providing Arizonans with comprehensive resources and support to navigate the health insurance landscape. Whether you’re looking for individual health insurance, family healthcare, short-term health insurance, or an ACA-approved health plan, we’re here to help. We believe that all Arizonans deserve access to superior health insurance, regardless of their pre-existing conditions.
Connect with an independent health insurance broker near you today.
