Part 1 answered questions about the Supreme Court’s ruling and the potential impact of its key provision, existing protections. The good news: Affordable Care Act/Obamacare continues to be in place with all existing protections.
Part 2 includes extended review plus addressing potential COVID-19 impacts.
In Part 1 of this two-part series, we reviewed the existing state definitions.
meaning: Most insurers use one of two definitions: The definition of “objective standard”, pre-existing condition, refers to the condition in which the patient was already receiving medical advice or treatment before enrolling in a new health plan (think job change). In the broader definition of “smart person”, a pre-existing condition is anything for which symptoms exist and a sane person would have sought treatment.
Others are reading…
Pre-ACA/Obamacare: In some cases, which definition was used was regulated by state law. Ten states did not specify either definition, 21 called for a “wise person” standard, and 18 called for an “objective standard.” Every state, every insurance plan can make its own decisions. Prior to the introduction of the ACA, there were no existing protections across the insurance industry.
The Patient Protection and Affordable Care Act (also known as Obamacare) was enacted on March 23, 2010. The law contained a deferral period that postponed the application of some exemptions. However, effective January 1, 2014, the ban on pre-existing condition exclusions in all health plans has been fully enforced for individual and group health plans. Disallow all exclusions, waiting periods, and conditions. There are no exceptions.
What are some examples of existing symptoms?
The top 10 most common diagnostic names are Diabetes, Acne, Anxiety, Asthma, Sleep Apnea, Depression, Pregnancy (when changing health insurance), Cancer, Heart Disease, and COPD. Other common conditions include extreme obesity, lupus, celiac disease/autoimmune disease/gluten sensitivity, high blood pressure, and any medical injury or illness you had before starting your new health plan.
More than 134 million Americans have pre-existing medical conditions, and ACA/Obamacare protection is important.
COVID-19 has identified a new group of pre-existing conditions. As the number of COVID-19 patients continues to rise, the long-term health effects are still unknown. The new figure also includes the more than 5 million children who have been infected with COVID-19 since the pandemic began. What are their long-term health implications? Pre-existing protection for this new group is a new dynamic for existing protection categories.
The term ‘long hauler’ refers directly to people infected with COVID-19 who have new long-term or short-term health effects after initial diagnosis. These people will receive new medical bills and a new list of “potential pre-existing conditions.”
Without ACA/Obamacare protection, insurance plans and employer-sponsored plans could exclude these new costs. This existing protection continues.
Day Egusquiza is President and Founder of Patient Financial Navigator Foundation Inc., an Idaho-based family foundation. For more information, call 208-423-9036 or visit the link below. pfnfinc.com. Have a Health Care Buzz topic? Share it with us at [email protected].
