Insurers asking about health to qualify?

[ArkTinkerer]

I thought the ACA stopped insurers from using pre-existing health conditions to block you from getting insurance. In looking for new insurance outside the marketplace it seems almost every agent has insurance you can only get if you don't have any pre-existing conditions. What changed? Is there a new loophole for insurers?

 

[Aerides]

Are you talking about short term non-market policies? Shop the exchange and you'll have no hassles.

 

[disneysteve]

I thought the ACA stopped insurers from using pre-existing health conditions to block you from getting insurance. In looking for new insurance outside the marketplace it seems almost every agent has insurance you can only get if you don't have any pre-existing conditions. What changed? Is there a new loophole for insurers?

Don’t go outside the marketplace.

 

[PaunchyPirate]

The rule applies to Marketplace policies.

"All Marketplace plans must cover treatment for pre-existing medical conditions."

https://www.healthcare.gov/coverage/pre-existing-conditions/

Emphasis added by me.

 

[ArkTinkerer]

Doesn't say just marketplace on the HHS website:

"
Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can’t charge women more than men."


https://www.hhs.gov/answers/health-...able Care Act,that new health coverage starts.

 

[Aerides]

Doesn't say just marketplace on the HHS website:

"
Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can’t charge women more than men."


https://www.hhs.gov/answers/health-...able Care Act,that new health coverage starts.

Right, but everything after that is saying it means Marketplace plans. Outside the market is wild west.

 

[PaunchyPirate]

Doesn't say just marketplace on the HHS website:

"
Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can’t charge women more than men."


https://www.hhs.gov/answers/health-...able Care Act,that new health coverage starts.

But it does when you click on the link right below that paragraph that says "More information on Marketplace plan coverage and pre-existing conditions." it takes you to the page I linked above where it spells out it is Marketplace plans that cannot exclude pre-existing conditions.

This article goes into more details:

https://www.verywellhealth.com/pre-existing-conditions-exclusions-1738633

I would assume the plans you are looking at are not ACA-compliant and/or are considered "Short-term Plans" or sharing ministry plans, fixed indemnity plans, or travel medical plans.... all of which can exclude pre-existing conditions.

 

[ArkTinkerer]

I would assume the plans you are looking at are not ACA-compliant and/or are considered "Short-term Plans" or sharing ministry plans, fixed indemnity plans, or travel medical plans.... all of which can exclude pre-existing conditions.

I'm specifically asking for HSA qualified plans. I don't think any of those you listed would qualify. But then I'm talking to insurance salespeople on the telephone. Not sure they are the most knowledgeable or able to do anything other than follow a computer prompted script.

This is similar to last year when the ACA only had two HSA plans available here. This year there is only one. And it is more expensive than other plans they offer. This year though the cheaper plans have higher deductibles than the HSA plan (which is required to be a "high deductible health plan"). Didn't think that was supposed to be possible either.

 

[RunningBum]

This is similar to last year when the ACA only had two HSA plans available here. This year there is only one. And it is more expensive than other plans they offer. This year though the cheaper plans have higher deductibles than the HSA plan (which is required to be a "high deductible health plan"). Didn't think that was supposed to be possible either.

Why would you think that? That's never been a requirement, nor reality from what I've seen.

 

[cathy63]

... This is similar to last year when the ACA only had two HSA plans available here. This year there is only one. And it is more expensive than other plans they offer. This year though the cheaper plans have higher deductibles than the HSA plan (which is required to be a "high deductible health plan"). Didn't think that was supposed to be possible either.

The IRS makes the rules around HSAs. For 2024, the minimum deductibles for self/family HDHP plans to qualify for HSAs are $1600/$3200 and the max OOP are $8050/$16,100.

I don't know who makes the rules for the ACA plans in general, but the max OOP for 2024 is $9450/$18,900. There are no requirements for deductibles but they are included as part of the max OOP.

 

[orchid55]

My understanding of the ACA plan deductibles is that they will continue to rise as long as the underlying cost of healthcare rises. If MRIs, X-rays and drugs are more expensive than the previous year the deductibles will rise as well. The reason is that the different level plans must keep the percentage of consumer medical expenses they pay the same. If the Bronze is meant to pay 60% of average costs and costs go up, the deductible must go up or the plan is too rich.

We did HSA ACA plans when possible partly because the deductible was lower than other Bronze plans.

 

[MichaelB]

ACA plan deductibles and cost sharing are based on actuarial value. The total cost of health care for a market segment is projected and averaged. A bronze ACA plan will cover 60% of that projected cost, silver 70%, gold 80% and platinum 90%.

 

[donheff]

I understand that pre-existing conditions coverage exclusions can also be imposed by supplementary insurance plans for people leaving Medicare Advantage. I don't have Medicare Part B or Advantage so I may be mistaken.

 

[RetiredHappy]

I have been buying off-exchange health insurance since 2017. The insurer asked about my pre-existing conditions back then. Once passed, they cannot drop you in the future as long as you stay with them. My health insurance is superior to what you can buy at ACA. Every top doctor accepts them, unlike ACA plans. Since we make too much, I don't qualify for any subsidies anyway, so I am better off with off-exchange private individual health insurance plan. Just for me - one person, a middle of the road silver plan costs me $1250 per month next year at age 61. I have 4 more years to look forward to paying high price plan until I reach Medicare age. Fortunately my husband is on Medicare Plan F and it is so much cheaper than mine.