ACA question

[Scuba]

DH and I currently have a “grandfathered” pre-ACA plan he purchased in 2013. We have kept the plan due to its excellent coverage, despite a high deductible and relatively high OOP max. DH just had a heart attack and had to have emergency quadruple bypass surgery so after many years of never meeting our deductible, DH just blew through his.

I believe it is correct that ACA plans can’t refuse someone due to pre-existing conditions. Is this correct? And can ACA plans charge more knowing he’s now has this “cardiac event”?

I’m worried that our pre-ACA plan might be able to cancel our coverage or just not renew our policy next year. We currently pay about $1,800/month for the two of us for a high deductible, non-HSA compliant PPO plan. We are still too young for Medicare. We are planning to stick with traditional Medicare plus supplemental coverage when each of us turns 65.

Can anyone reassure me that we should still be able to buy a good PPO plan now and after going on Medicare?

 

[MichaelB]

DH and I currently have a “grandfathered” pre-ACA plan he purchased in 2013. We have kept the plan due to its excellent coverage, despite a high deductible and relatively high OOP max. DH just had a heart attack and had to have emergency quadruple bypass surgery so after many years of never meeting our deductible, DH just blew through his.

I believe it is correct that ACA plans can’t refuse someone due to pre-existing conditions. Is this correct? And can ACA plans charge more knowing he’s now has this “cardiac event”?

I’m worried that our pre-ACA plan might be able to cancel our coverage or just not renew our policy next year. We currently pay about $1,800/month for the two of us for a high deductible, non-HSA compliant PPO plan. We are still too young for Medicare. We are planning to stick with traditional Medicare plus supplemental coverage when each of us turns 65.

Can anyone reassure me that we should still be able to buy a good PPO plan now and after going on Medicare?

You are correct. ACA is guaranteed enrollment so you cannot be denied a policy, and coverage is standard for all policies, there are no exclusions because of preexisting conditions. Price is based on age, not health. You are safe.

Whether you can get a PPO depends on what policies are offered in your area. The best way to find out is go to Healthcare.Gov and look at the policy offerings in your zip code.

 

[RetiredAndLovingIt]

You're fine, they can't use his health against him or charge more.
I was able to get an ACA plan with BCBS that was identical in coverage to the plan offered when I was working. Since then I've moved on to a Kaiser plan which is good as well.
I'm in California and we have lots of choice, at least where I am. Looks like you're in California as well so start here. Covered California is a great website and you don't need to create an account to start shopping, it's all income based and silver plans are the best deal, at least in my opinion.

https://www.coveredca.com/

 

[cathy63]

I think you're in the Coachella Valley? Both Blue Shield California and Health Net Ambetter have PPO ACA plans in that area. You can see what's available this year at coveredca.com and check which of your current docs is in either network. No guarantees the same plans will be available next year, but I think the marketplace has been pretty stable in that area.

 

[RetiredAndLovingIt]

Right now open enrollment is closed so you might have to wait till next year unless of course you lose your insurance or have another qualifying event

 

[RetiredAndLovingIt]

These charts might help with income questions

https://www.coveredca.com/pdfs/FPL-chart.pdf

https://laborcenter.berkeley.edu/wp-content/uploads/2021/03/2021-03-MAGI-Summary.pdf

 

[ivinsfan]

Scuba this is what I mean by mental stress, hubby is still in hospital and you are already worried about next years insurance. You won't believe the things that can pop into your head and refuse to leave. It's tough to deal with. You insurance will continue it's not like car insurance where they can cancel you or raise your rates