Will AHCA make you pay more for pre existing conditions
Health Insurance Print

Do I Need to Worry About Paying More For a Pre-Existing Condition?

In Independent, Plain Language

Will the American Health Care Act (AHCA) of 2017 be a comeback of health insurance horror stories for people with pre-existing conditions? No and Maybe.

No: You Cannot Be Denied Health Insurance for a Pre-Existing Condition

Under both the ACA (which is still the law of the land) and the AHCA, health insurance must be offered to everyone, even if they have a pre-existing condition.

Maybe: If 3 Things Happen, You Could be Charged More for Pre-Existing Conditions

Under the ACA insurance premiums couldn’t take into account a person’s health status.  So a perfectly healthy 30 year old single person buying a silver plan and a chronically sick 30 year old single person buying a silver plan would pay the same premium.

Under the proposed AHCA, your insurance premium could go up if ALL of the following 3 things happen:

  1. Waiver: Your state applies to the federal government for a waiver. Waivers are automatically granted unless the federal government denies the application. This waiver allows state government to allow health insurance companies to charge higher premiums if the following 2 conditions are met:
  2. Insurance Coverage Lapses: You don’t have health insurance for more than 63 continuous days.
  3. You have a Pre-Existing Condition Defined by the State:  The AHCA does not outline what a pre-existing condition is. #IAmAPreexistingCondition shares on Twitter and Facebook shares of the long list of pre-existing conditions comes from which pre-existing conditions health insurance companies sometimes charged more for prior to the ACA. These lists are speculation. Each individual state will decide which pre-existing conditions health insurance companies will be allowed to charge more for. These decisions will not be made unless the AHCA is passed in its present form.

Who is Most Likely Impacted?

These are educated guesses based on past behavior:

  • States who did not expand Medicaid are most likely to apply for the waiver
  • Your state didn’t expand Medicaid and you fall in the gap of needing coverage, but cannot afford the full price of health insurance on your state exchange
  • Healthy individuals who decided to not get health insurance and have a sudden onset of illness
  • No individual health insurance offered in your area and you lose your job, you are self-employed, you retire before the age of 65, or your employer doesn’t offer group health insurance

Worse Case Scenario: What if My Premiums Go Up and I Can’t Afford Them?

If your state applies for a waiver, it is also required to have a high risk pool to help hold your premiums down. The federal government will help allocate this money to the states. The question is whether these pools of money will be sufficient to cover everyone in the state who needs it.