You May Not Be Eligible For Guaranteed Health Insurance – Yet


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It seems like every week I have to answer the question, “When will acceptance for health insurance be guaranteed?”

Currently, insurance companies accept as many people with “pre-existing” conditions as they can.  However, there are some people who have waited too long, for whatever reason, to get health insurance.  They are the ones who the politicians and media have elected to use to scare Americans and create a health insurance crisis.

Let’s look at the facts.

CHILDREN

Of course, children should not be harmed because their parents did not provide health insurance.  Children are protected right away in the Patient’s Protection and Affordable Care Act.

1.  Section 2714 of the law says, “A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child until the child turns 26 years of age.”

What this means is that children are allowed to stay on their parent’s health insurance plan until they are 26.  No longer must a young adult be a full-time student in order to stay on his parent’s health insurance plan after his 18th birthday.

2.  Section 2707 of the law says, “If a health insurance issuer offers health insurance coverage in any level of coverage specified under the issuer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of a plan year, have not attained the age of 21.

Unfortunately, most insurance companies responded to this mandate by eliminating their “Child-only” health insurance plans.   Even if their response was not “right” to everyone, their withdrawal of these types of policies made sound business sense.

There was nothing to stop parents from not paying premiums to insure their children as long as they knew that they could get insurance and have someone else pay for medical bills if their child got sick in the future.

Since the law was passed, several state governments have made a compromise with private health insurance companies.  In a handful of states, health insurance companies will now offer guaranteed issued, “Child-only” health insurance policies during an open enrollment period similar to the one Medicare uses.   Here in Texas, that open enrollment is 6 weeks during the late spring and early summer.

People who want “Child-only” health insurance, must submit their application during that open enrollment window.  If that is something that you are looking at, be aware that many child-only policies are high-deductible plans that offer coverage for only catastrophic and preventive medicine.  These policies will not help you much if your child breaks an arm on the playground or catches a cold at school.  You will still have to pay whatever your doctor charges up to the plan’s deductible.

This does not mean that children cannot get insurance during the rest of the year.  It only means that they must be accompanied on the application by an insurable adult.

ADULTS

The Patients Protection and Affordable Care Act does not just protect children.  It also addresses some concerns that adults have.

1.  Section 1101 of the PPACA says, “Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.

With this, the PPACA created a place for adults to get health insurance through the government if they are unable to get it through private health insurance companies.

Unfortunately, like many government programs, this program has eligibility requirements.  The new plan is only available for Americans who…

“(1) is a citizen or national of the United States or is lawfully present in the United States (as determined in accordance with section 1411);

(2) has not been covered under creditable coverage (as defined in section 2701(c)(1) of the Public Health Service Act as in effect on the date of enactment of this Act) during the 6-month period prior to the date on which such individual is applying for coverage through the high risk pool; and

(3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.”

I understand the reasoning for the first and third.  What I do not understand is why an individual must go completely without health insurance for 6 months before they are eligible for the government program.

Other than this “High Risk Pool” program, adults are still subject to medical underwriting for major medical health insurance until the new American Health Insurance Exchanges begin to operate in 2014.  At that time, all Americans will be guaranteed to be accepted by health insurance companies.

Be advised that this information is based on a law that is subject to change.  Currently, part of the PPACA is being challenged by 26 states on constitutional grounds in the U.S. Supreme Court.  The entire law, or just a portion of it could be over-turned by the courts.

Also, we have a national election for president and congress this year.  One of the stated aims of the opposition party is to repeal Obamacare and replace it with another law.

Adding to the problems is the fact that many state legislatures only meet every other year.  Between now and the time that guaranteed issue of health insurance for all Americans is scheduled to happen in 2014, many state legislatures will only meet one more time.

The question of guaranteed approval for health insurance is still up in the air.  There are only two things that we know now.

1.  Children are guaranteed approval for health insurance, regardless of their health history.

2.  Adults are not guaranteed approval for health insurance.  They are still subject to medical underwriting for another 2 years.

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