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Do I Need to Be Concerned About Pre-existing Conditions?

Thoughtful pregnant woman looking out the windowPre-existing conditions are conditions that the patient has already received medical advice or treatment for, prior to enrollment in a new insurance plan.

They used to be extremely problematic for many people, but not anymore. Now you don’t need to be concerned about pre-existing conditions.

Why not?

Under Obamacare, health insurance companies can’t refuse to cover you or charge more just because you have a pre-existing condition.

This is a huge change that took place for plans beginning on or after January 1, 2014. The fear of pre-existing conditions used to prevent people from moving or switching jobs because they didn’t want to lose their existing health plan. No one wanted their rates to skyrocket due to their pre-existing conditions.

There is an exception, however. This rule does not apply to “grandfathered” individual health insurance policy that was bought for you or your family on or before March 23, 2010 that hasn’t been changed in specific ways that reduce benefits or increase costs.

This change was a welcome one to many individuals who were previously unable to get healthcare coverage because of their pre-existing conditions.

If you have questions about your insurance or pre-existing conditions, let us know!

All this month we are answering your questions and we will be answering even more in this month’s webinar on January 27, 2016 at 2 p.m. Eastern. Bring your questions to the webinar or submit them in advance by email or on Facebook or Twitter.

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What Preventive Services are Covered by My Healthcare Plan?

Paediatrics Medical ConceptObamacare made a lot of changes to insurance and healthcare. One thing it changed is what preventive services must be covered by your insurance without having to pay a copayment when delivered by a network provider. If you are under a new health insurance plan or a policy beginning on or after September 23, 2010, here are some of the services that must be covered by your healthcare plan.

For Adults:

  • Alcohol misuse screening and counseling
  • Aspirin use for men and women of certain ages
  • Blood pressure screening
  • Cholesterol screening for adults of certain ages or at high risk
  • Depression screening
  • Many immunization vaccines including Hepatitis A and B, Herpes Zoster, Human Papillomavirus, Flu Shot, Measles, mumps, rubella, Meningococcal, Pneumococcal, and more
  • Obesity screening and counseling
  • Syphilis screening for adults at higher risk

For Women:

  • Anemia screening for pregnant women
  • Bacteriuria urinary tract or other infection screening for pregnant women
  • Breast cancer mammography screenings every 1 to 2 years for women over 40
  • Osteoporosis screening for women over 60, depending on risk factors
  • Tobacco use screening and interventions for all women and expanded counseling for pregnant users

For Children:

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children
  • Depression screening for adolescents
  • Immunization vaccines for children including Diphtheria, Tetanus, Pertussis, Hepatitis A and B, Flu Shot, Measles, Mumps, Rubella, Varicella, and more

You can find out more about the many other preventive services offered on hhs.gov. Take advantage of these preventative services and stay healthy in the New Year!

All month long we are answering your questions. What do you want to know about your healthcare? Leave your questions in the comments section of the blog, email them to me, or ask them on Facebook or Twitter. Then join me on January 27th, 2016 for a Q&A webinar where I will answer your questions. Register here.

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Why Isn’t My Insurance Covering Anything?

Pharmacist Showing Product To ClientI often receive questions from people who say they went to the doctor but their visit wasn’t paid for by their insurance, or their prescriptions weren’t covered. These people want to know why they are paying for health insurance if it isn’t going to cover anything.

In most cases, the answer is that they haven’t yet met their deductible. Many plans cover doctor’s visits and prescriptions, but only after the patient has paid first. If your plan has a deductible, it means that you will pay out-of-pocket for expenses up to that amount, and then insurance will kick in.

So let’s say, for example, that you have a $250 deductible with your insurance plan. You may have to pay out-of-pocket for doctor’s visits or copays until your total expenses reach $250. To be clear, that doesn’t mean $250 per instance. You may pay $60 for a prescription in January, $30 for another in February, and so on. All of those expenses get totaled—in this example you are up to $90. Once you have paid a total of $250, your insurance will kick in and cover your expenses for the rest of the year.

These costs usually reset at the beginning of the year. Hello, January. Early in the year, you may be paying out-of-pocket, but as the year goes on and you meet your deductible, your insurance may start paying on your behalf.

As you budget for the year, you may want to keep these expenses in mind. In fact, you may want to set aside some extra money each month toward the end of the year to cover your out-of-pocket costs at the beginning of the next year. You may also consider opening a flexible spending account (FSA) or health savings account (HSA) in the future to help cover your out-of-pocket costs.