Pre-existing condition

[jkrm]

I am 62 and thinking about retirement. But I am a bit concerned about the intent to repeal ACA. I know that the provision that health insurance companies must accept patients regardless of pre-existing conditions is very popular and likely to survive (and is in the currently-being debated bill), but I want to be very cautious.

So here is my concern. If I retire now and purchase a health insurance plan for my wife and me, can the insurance company later drop us if the provision preventing refusal for a pre-existing condition goes away? Since my wife just turned 62 (and does not work) I need to be sure we will have coverage for three years, till we are both 65.

Thanks!

 

[zinger1457]

ACA plans will stay in place until 2020 under the current proposed changes. I haven't heard of any new proposals that would allow denying coverage for those with pre-existing conditions, I think the chances of that happening are slim and none. What the premiums will be for older adults approaching 65 is certainly a concern.

 

[2017ish]

Mostly agree with zinger. At least if one maintains coverage, it appears likely that pre-existing condition insurability issues will be avoided. (Assuming individual policies are available for purchase at your place of residency.)

 

[MichaelB]

So here is my concern. If I retire now and purchase a health insurance plan for my wife and me, can the insurance company later drop us if the provision preventing refusal for a pre-existing condition goes away? Since my wife just turned 62 (and does not work) I need to be sure we will have coverage for three years, till we are both 65.

jkrm, the truth is no one knows. There are proposals to change the rules currently being considered in Congress. If they do change, we may then have enough information to answer your question. Until then, we are all speculating.

 

[scrabbler1]

I am 62 and thinking about retirement. But I am a bit concerned about the intent to repeal ACA. I know that the provision that health insurance companies must accept patients regardless of pre-existing conditions is very popular and likely to survive (and is in the currently-being debated bill), but I want to be very cautious.

So here is my concern. If I retire now and purchase a health insurance plan for my wife and me, can the insurance company later drop us if the provision preventing refusal for a pre-existing condition goes away? Since my wife just turned 62 (and does not work) I need to be sure we will have coverage for three years, till we are both 65.

Thanks!

Maybe you can split the difference. Back in the 1990s, my dad was in his early 60s and wanted to retire. But he needed to keep uninterrupted HI coverage because his wife (my mom) was ill with cancer and undergoing a lot of treatment. So, what he did was to keep working until he turned 63.5 then go on COBRA for another 18 months until he turned 65 and became eligible for Medicare. Sadly, she died a few months before he turned 65.

Speaking of COBRA, I am not sure if the ACA allows an exchange-bought policy if one is eligible for COBRA.

 

[broadway]

Speaking of COBRA, I am not sure if the ACA allows an exchange-bought policy if one is eligible for COBRA.

Well, if it isn't allowed, then I what I did was wrong.
In December 2013, when I signed up for an ACA exchange policy starting January 2014, I still was eligible for about 14-15 months of COBRA.

 

[2017ish]

...

Speaking of COBRA, I am not sure if the ACA allows an exchange-bought policy if one is eligible for COBRA.

I remembered seeing this discussed in the past. You may reject COBRA and go to the ACA exchange:

If you decide not to take COBRA coverage, you can enroll in a Marketplace plan instead. Losing job-based coverage qualifies you for a Special Enrollment Period. This means you have 60 days to enroll in a health plan, even if it’s outside the annual Open Enrollment Period.

https://www.healthcare.gov/unemployed/cobra-coverage/

 

[jkrm]

Thanks for the replies. scrabbler1, working till I am 64 and then going on COBRA (my wife is six months younger than I am, so I'd need 18 months to keep her covered) is my back-up plan. But I am hoping not to have to do that. I didn't know I might have no choice but to take COBRA for a while - I'd rather have a lower-cost high-deductible plan (bronze would suit us well), but if I have to take the gold COBRA plan, so be it.

My plan had been to retire this past winter, but after the election the fate of ACA became unknown. I am aware that the current proposal keeps the pre-existing condition provision, and that the likelihood of it's going away is probably very very low, but I prefer to be cautious so I am holding off. But I am getting antsy!

 

[MichaelB]

Thanks for the replies. scrabbler1, working till I am 64 and then going on COBRA (my wife is six months younger than I am, so I'd need 18 months to keep her covered) is my back-up plan. But I am hoping not to have to do that. I didn't know I might have no choice but to take COBRA for a while - I'd rather have a lower-cost high-deductible plan (bronze would suit us well), but if I have to take the gold COBRA plan, so be it.

The backup plan sounds reasonable. One question, though, will your employer insurance cover your wife for the 6 months when you no longer need it? Or does it end when you become eligible for Medicare? Not looking to raise your stress level, but it is an important detail.

 

[MichaelB]

Speaking of COBRA, I am not sure if the ACA allows an exchange-bought policy if one is eligible for COBRA.

Yes, it does. When leaving your job you can choose between Cobra or ACA. If you choose Cobra, you can only then change to an ACA policy during open enrollment.

 

[broadway]

Yes, it does. When leaving your job you can choose between Cobra or ACA. If you choose Cobra, you can only then change to an ACA policy during open enrollment.

As I recall the timing was that the open enrollment at my former employer was in December which coincided with the open enrollment of the first year of ACA. I could be wrong.

I took a leap of faith and signed up with ACA for the premium subsidy since I initially had no job and no unemployment.

 

[NameRedacted]

Worst case scenario - if you lose your job or something - you could consider moving to New York State. Since the early nineties it's been illegal to deny coverage based on pre-existing conditions.


There may be other states with similar provisions - not sure - but it's worth investigating.

 

[jkrm]

Thanks again, all. Some good suggestions and information here. Probably whatever replaces ACA, if it gets replaced, will cover pre-existing conditions and this will be a non-problem anyway, but it's good to know the options.

I have some info on COBRA at home (I am on vacation now) and I am pretty certain that even if I go on Medicare, my wife can still be covered. I remember looking at that in particular.