As you review your insurance options during open enrollment season, beware of plans that seem too good to be true. You might encounter offers for seemingly affordable plans that won’t cover your health services because you have a pre-existing condition like PH.
Sometimes called “junk” health plans, these insurance policies include short-term, limited duration health plans, association health plans, health sharing ministries and Farm Bureau plans.
Although the Affordable Care Act established protections for people with pre-existing conditions, new laws and regulations have relaxed some of those protections and reduced government oversight of insurance companies.
Before the ACA become law in 2010, people with serious or chronic conditions like pulmonary hypertension often struggled to find affordable, adequate health insurance. When the law went into effect, it required insurance companies to provide comprehensive coverage and prevented them from discriminating against people with serious or chronic pre-existing conditions.
Since then, millions of people have relied on health care coverage through insurance marketplaces created by the Affordable Care Act. The marketplaces serve people with limited incomes as well as those with pre-existing conditions.
Common features of ‘junk’ plans
- Much lower monthly premiums than ACA health plans.
- Don’t cover prescription drugs, specialist visits, inpatient hospital stays, mental health or substance abuse treatment or maternity care.
- Limits how much the plan will pay in benefits.
- No cap on your out-of-pocket costs.
- Might charge more for coverage based on your health status.
How to avoid ‘junk’ plans
It’s hard to avoid ads for these heavily marketed plans. They often show up online in top search results for “health insurance.”
Instead of using a search engine, visit the Marketplace Health Exchange or your state’s ACA insurance exchange. All plans listed comply with the ACA, which means they cover essential health benefits and include financial protection against unlimited out-of-pocket costs.
When reviewing your options, make sure a plan:
- Doesn’t require access to your health history or use medical underwriting.
- Covers pre-existing conditions.
- Guaranteed to be renewable as long as you keep paying the premiums.
- Covers prescription and specialty drugs, maternity care and mental health care.
- Caps out-of-pocket costs for medically necessary, in-network care.
Related topics
Contact PHA’s Treatment Access program at 240-485-0758.
Categories:
