Arthritis: An Insurable Pre-Existing Condition

Arthritis is considered a pre-existing condition by insurance companies, and patients in the US are protected by the Affordable Care Act (ACA) which ensures coverage and access to health insurance for people living with osteoarthritis, rheumatoid arthritis and other types of arthritis. Under the ACA, patients cannot be refused insurance coverage, charged higher premiums or dropped from coverage because of their arthritis. In India, several autoimmune diseases, including rheumatoid arthritis, are covered under health insurance plans.

Arthritis patients can't be denied insurance coverage or charged higher premiums under the ACA

Arthritis patients have important rights that protect their access to healthcare. The Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010, and it offers protections to help ensure coverage and access to health insurance for people living with osteoarthritis, rheumatoid arthritis, and other types of arthritis.

The ACA prohibits insurers from denying coverage to people with a pre-existing condition like arthritis. This means that arthritis patients cannot be refused insurance coverage or charged higher premiums because of their condition. Insurers also cannot cancel your insurance coverage because you are sick. If you are uninsured or under-insured, you can shop around on the Health Insurance Marketplace at www.healthcare.gov. Gold and platinum plans have higher monthly premiums but lower out-of-pocket costs, which may be better if you are paying for arthritis medicines and rheumatologist visits.

The ACA also allows children to stay on their parents' insurance up to the age of 26, which is good news for parents of the nearly 300,000 kids with juvenile arthritis. This means that children with arthritis cannot be denied coverage, and insurers must keep them on their parents' policy until age 26, even if they are married or eligible for another employer's plan.

In addition to the protections offered by the ACA, arthritis patients can also benefit from financial assistance programs offered by organizations like NeedyMeds and Good Days, which help with costs such as prescription medication and travelling to medical appointments.

Arthritis patients can comparison shop for insurance on the Health Insurance Marketplace

Arthritis patients in the US have several options when it comes to insurance coverage. The Patient Protection and Affordable Care Act (ACA), signed into law in 2010, offers protections to ensure coverage and access to health insurance for people living with osteoarthritis, rheumatoid arthritis, and other types of arthritis. Here's what arthritis patients need to know about comparison shopping for insurance on the Health Insurance Marketplace:

Understanding the Health Insurance Marketplace

The Health Insurance Marketplace is a platform where individuals can shop for health insurance plans. It was established as part of the ACA to provide a centralized and standardized way to compare and select health insurance. The Marketplace is especially beneficial for those who are uninsured or underinsured, as it offers a range of plan options to meet different needs and budgets. The website www.healthcare.gov serves as a central hub for individuals to explore and enroll in plans during the open enrollment period.

Key Considerations for Arthritis Patients

When comparison shopping for insurance on the Health Insurance Marketplace, arthritis patients should consider the following:

• Plan categories: The Marketplace offers plans in four categories: Bronze, Silver, Gold, and Platinum. Gold and Platinum plans typically have higher monthly premiums but lower out-of-pocket expenses, which can be advantageous for arthritis patients who require frequent rheumatologist visits and medications.
• Monthly premiums: Arthritis patients should evaluate the monthly cost of each plan. Higher-tier plans usually come with higher premiums, so patients must balance affordability with their anticipated medical needs.
• Annual deductibles: Understanding the annual deductible, or the amount patients must pay out of pocket before insurance coverage kicks in, is crucial. Plans with lower deductibles may be preferable for arthritis patients who anticipate frequent medical expenses.
• Services covered: Arthritis patients should carefully review the types of services covered by each plan. This includes confirming that arthritis-related treatments, medications, and specialist visits are included.
• Essential health benefits: Under the ACA, both employer-sponsored plans and Marketplace plans must cover essential health benefits. These include hospitalization, prescription drugs, and the management of chronic diseases like arthritis.
• Cost-saving opportunities: Arthritis patients can consider plans that offer lower out-of-pocket costs for medical visits and prescription drugs deemed essential health benefits. Additionally, plans with higher premiums may result in lower overall costs if they provide more comprehensive coverage for arthritis-related expenses.

Additional Resources

Arthritis patients can utilize online resources, such as arthritis.org, to better understand their health coverage options, choose the right plan, and manage costs effectively. These resources provide valuable information on navigating insurance coverage, reducing healthcare costs, and advocating for accessible arthritis care.

In summary, arthritis patients can take advantage of the Health Insurance Marketplace to comparison shop for insurance plans that best meet their needs. By considering plan categories, premiums, deductibles, covered services, and cost-saving opportunities, patients can make informed decisions about their healthcare coverage.

Arthritis patients have access to essential health benefits

Guaranteed Insurance Coverage

Under the ACA, individuals with arthritis cannot be denied or dropped by insurance companies due to their condition. This means arthritis patients are guaranteed to obtain and maintain health insurance coverage, regardless of their medical history.

Access to a Range of Treatment Options

Essential health benefits cover a wide range of services, including hospitalization for surgery, prescription drugs, and the management of chronic diseases like arthritis. Arthritis patients can access necessary treatments, such as joint replacement surgery, physical therapy, and medication, without worrying about insurance limitations.

Elimination of Copayments for Preventive Care

Copayments and deductibles for preventive care have been eliminated under the ACA. This means arthritis patients won't have to pay out of pocket for preventive services, making it easier to manage their condition and maintain their health.

Lower Out-of-Pocket Costs

Annual out-of-pocket costs for medical visits and prescription drugs related to essential health benefits are limited. This helps arthritis patients better manage their finances while accessing the necessary treatments and medications.

Access to Cheaper Biologic Drugs

The ACA has accelerated the introduction of biosimilar versions of biologics, which are more affordable. Arthritis patients can now access cheaper biologic drugs that slow the progression of joint damage, without compromising their effectiveness.

Protection Against Lifetime Coverage Limits

Insurance companies are prohibited from imposing lifetime limits on essential health benefits. This provision ensures that arthritis patients won't max out their health coverage, providing peace of mind for those requiring long-term or extensive treatment.

In summary, the ACA provides arthritis patients with essential health benefits that guarantee access to necessary treatments, protect against discrimination, and reduce financial burdens. These provisions ensure that arthritis patients can lead healthier lives without worrying about insurance limitations or excessive costs.

Arthritis patients can't max out their health coverage

Arthritis patients in the US are protected by the Patient Protection and Affordable Care Act (ACA), which was signed into law in 2010. This legislation ensures that arthritis patients cannot be refused insurance coverage, charged higher premiums, or dropped from coverage because of their condition.

The ACA also offers arthritis patients the ability to comparison shop for insurance. If a patient is uninsured or under-insured, they can shop around on the Health Insurance Marketplace, which offers four categories of plans with varying monthly premiums and out-of-pocket costs. Gold and platinum plans, for example, have higher monthly premiums but lower out-of-pocket expenses, which could be beneficial for patients paying for arthritis medicines and rheumatologist visits.

Arthritis patients cannot max out their health coverage. Before the ACA, insurance companies could limit how much they would pay for coverage over a person's lifetime, with amounts sometimes reaching $1 million or more. However, this is no longer the case for services deemed essential health benefits, which include hospitalization for surgery, prescription drugs, and the management of chronic diseases like arthritis.

The ACA also provides arthritis patients with access to cheaper biologic drugs, which slow the progression of joint damage. Medicare will reimburse for biological and biosimilar drugs in the same way. Additionally, patients can appeal rejected claims and have the decision reviewed by an independent organization.

There are also various state-based and private consumer assistance programs that help arthritis patients with health insurance problems, understanding their coverage options, and reducing healthcare costs. These programs include State Health Insurance Assistance Programs (SHIPs), Medicare Savings Programs, and the Program of All-inclusive Care for the Elderly (PACE).

Arthritis patients will pay lower out-of-pocket costs

Arthritis patients in the US can benefit from the Patient Protection and Affordable Care Act (ACA), which offers protections to ensure access to health insurance for people living with osteoarthritis, rheumatoid arthritis, and other types of arthritis.

Under the ACA, patients cannot be refused insurance coverage, charged higher premiums, or dropped from coverage because of their arthritis. This means that arthritis patients will have the same access to insurance coverage as those without the condition.

The ACA also ensures that arthritis patients will pay lower out-of-pocket costs for their medical visits and prescription drugs, as long as these are deemed essential health benefits. Essential health benefits include hospitalization for surgery, prescription drugs, and the management of chronic diseases like arthritis. In the past, insurance companies could impose lifetime limits on these services, but under the ACA, there are no longer any limits on essential health benefits.

For example, a single hip replacement surgery can cost $100,000, and biologic drugs can exceed $2,500 per month. Without the ACA, patients could quickly reach a coverage limit and be responsible for these high costs. However, with the ACA, there are no longer any limits on essential health benefits, which include joint replacement surgery and biologic drugs for arthritis patients.

In addition to lower out-of-pocket costs, arthritis patients can benefit from other provisions of the ACA, such as the ability to comparison shop for insurance on the Health Insurance Marketplace and the option to appeal rejected claims. The ACA has also paved the way for biosimilar versions of biologic drugs, which are cheaper and help slow the progression of joint damage.

Frequently asked questions