Cancer And Insurance: Pre-Existing Condition Clause

If you have cancer and are considering changing your insurance provider, it is important to know your rights. In the US, the Affordable Care Act (ACA) makes it illegal for health insurance companies to deny coverage or charge higher rates to individuals with pre-existing conditions, such as cancer. This means that your new insurance provider cannot refuse to cover your cancer treatment or charge you more for having had cancer before the start of your new plan. However, it is important to note that grandfathered health plans, which were in place before the ACA was passed, may not include these protections. Therefore, if you are considering changing insurance providers, it is crucial to carefully review the details of your current and prospective plans to ensure that you do not experience any gaps in coverage for your cancer treatment.

Cancer is considered a pre-existing condition

Before 2014, health insurance companies were allowed to refuse to cover individuals with pre-existing conditions, such as cancer, or charge them a higher premium. This often made premiums unaffordable for those with pre-existing conditions. However, since 2014, federal requirements have prohibited health insurance plans from denying coverage or charging higher premiums to individuals with pre-existing conditions. These protections are provided by the Affordable Care Act (ACA), which ensures that individuals with pre-existing conditions, such as cancer, have access to affordable health insurance.

It is important to note that "grandfathered" health plans, which were in place before the ACA was passed, are not subject to these protections. These plans may deny coverage or charge higher premiums to individuals with pre-existing conditions like cancer. Therefore, when changing insurance plans, it is crucial to ensure that there is no gap in coverage by allowing one policy to lapse before the new one starts.

Additionally, when managing health insurance during cancer treatment, it is recommended to keep track of medical expenses, understand billing and out-of-pocket costs, and stay up-to-date with payments to avoid lapses in coverage. Cancer patients can seek support from organisations like the American Cancer Society to navigate financial and insurance matters during their treatment journey.

Insurance companies cannot deny coverage for pre-existing conditions

In the United States, insurance companies cannot deny coverage or charge higher rates for pre-existing conditions. This includes health problems that existed before the individual enrolled in a health plan, such as cancer, diabetes, asthma, and pregnancy. The Affordable Care Act (ACA), passed in 2010, made it illegal for insurers to deny coverage or charge higher rates based on pre-existing conditions. This protection applies to all Marketplace plans and Medicaid and CHIP programs.

Prior to the ACA, insurance companies could deny coverage, charge higher premiums, or exclude coverage for pre-existing conditions. This often made insurance unaffordable for individuals with pre-existing conditions. The ACA has helped increase access to health insurance for individuals with chronic health issues, including cancer patients, by prohibiting these practices.

It is important to note that "grandfathered" health plans, or plans purchased before March 23, 2010, are not subject to the ACA's rules and may not cover pre-existing conditions. Individuals with pre-existing conditions should be aware of this exception and consider switching to a Marketplace plan that provides coverage for pre-existing conditions.

Overall, the ACA has helped protect individuals with pre-existing conditions by ensuring they cannot be denied coverage or charged higher rates. This has improved access to healthcare and is particularly beneficial for individuals with chronic illnesses or ongoing health needs.

Grandfathered health plans and pre-existing conditions

Grandfathered health plans refer to individual or group health insurance policies purchased or established on or before March 23, 2010. These plans were bought directly from insurance companies or employers, rather than through the Marketplace.

Grandfathered plans are not required to meet certain provisions of the Affordable Care Act (ACA) and may not include the same rights and protections as other plans under the ACA. Specifically, they are not mandated to cover preventive health services, and they can charge higher premiums based on health status or gender. Crucially, they are also not required to cover pre-existing conditions.

To maintain their grandfathered status, these plans cannot make significant changes that reduce benefits or increase costs for consumers. Examples of such changes include substantially cutting benefits for a particular condition, increasing cost-sharing percentages, or raising fixed amount cost-sharing by more than medical inflation plus 15%.

If a grandfathered plan loses its status by making significant changes, consumers in these plans will gain additional benefits, including coverage of recommended preventive services and patient protections such as guaranteed access to OB-GYNs and pediatricians.

The Affordable Care Act and pre-existing conditions

In the United States, the Affordable Care Act (ACA) makes it illegal for health insurance companies to deny coverage or charge higher rates to individuals with pre-existing conditions. This means that if you have had cancer before enrolling in a new health plan, your insurer cannot legally deny you coverage or charge you higher premiums because of your medical history.

Prior to the implementation of the ACA in 2010, insurance companies could review applications for enrollment and deny coverage or offer coverage at inflated rates if they determined that the applicant had a pre-existing condition. This often made health insurance unaffordable for individuals with pre-existing conditions, including cancer patients and survivors.

The ACA prohibits the use of pre-existing conditions to deny coverage, increase premiums, or impose waiting periods. This means that once an individual is enrolled in an insurance plan, the insurer cannot refuse to cover treatment for their pre-existing condition or raise their rates based on their health status. Additionally, insurance companies cannot charge women more than men due to pre-existing conditions.

It is important to note that "grandfathered" health plans, which were purchased individually before March 23, 2010, are exempt from this regulation and may not cover pre-existing conditions. These plans were bought outside of the Marketplace and may have other restrictions. However, individuals with "grandfathered" plans who want pre-existing conditions covered can switch to a Marketplace plan during Open Enrollment or buy a plan outside of Open Enrollment and qualify for a Special Enrollment Period.

The ACA has made it easier for individuals with pre-existing conditions, such as cancer, to obtain affordable health insurance. It provides protections and choices for individuals and their families, ensuring that they have access to essential health benefits.

Cancer treatment and health insurance

Overview

Cancer care can be expensive, and even with the best health insurance, there are often out-of-pocket costs such as co-insurance, deductibles, co-pays, out-of-network costs, and medications. It is important to have a health insurance plan that covers the costs of cancer care and to keep the policy up to date with no coverage gaps.

Types of Health Insurance

There are two main types of health insurance: private (commercial) and public (government-funded). Most people in the US get health insurance through their employer, but if you don't have insurance through your employer, you can see if you're eligible for government-funded insurance.

The Affordable Care Act (ACA)

The Affordable Care Act (ACA), passed in 2010, made it illegal for insurers to deny coverage or charge higher rates due to pre-existing conditions like cancer. The ACA also helps people who need it to get health insurance, requiring all health plans sold in the health insurance marketplaces to cover certain essential benefits, including:

• Chronic disease care
• Mental health services
• Outpatient treatment
• Prescription drug coverage
• Rehabilitation services

Managing Your Health Insurance

• Do not let your health insurance lapse. Pay your premiums and other costs on time, as new insurance can be hard to get.
• If you are changing insurance plans, make sure there is no gap between the old and new policies, including when switching to Medicare.
• Call the insurer before planned medical services, such as surgery, procedures, or treatments, to see if you need prior authorization.
• Check each medical bill to make sure it is correct, and dispute any charges that don't seem right.
• Keep track of your medical bills, insurance claims, and payments. This will help you manage your money and deal with any questions or disputes that may arise.
• If you have limited finances, ask your cancer care team for help from a caseworker, financial counsellor, or social worker. Many health care facilities can work with you to set up a payment plan.

Other Resources

In addition to health insurance, there are other resources available to help with the cost of cancer treatment:

• Supplemental insurance: This can help cover expenses not covered by your primary insurance or costs within your existing plan.
• Disability insurance: This replaces income lost if health issues, including long-term illnesses, keep you from working.
• Hospital indemnity insurance: This provides limited coverage for hospital stays, usually a fixed amount for each day.
• Long-term care insurance: This provides coverage for long-term care costs, such as nursing home care, which are often not fully covered by private insurance plans or Medicare.

Frequently asked questions