healthcare-reform

What Obamacare means to you if have a pre-existing condition

Sep. 30, 2013 at 4:43 PM ET

Shopping Health Care: Pre-Existing Condition
iVillage /
Shopping Health Care: Pre-Existing Condition

Anyone who’s had or has cancer, diabetes or even a pregnancy that resulted in a C-section has always had a hard time getting insurance, either because they were outright denied or it was prohibitively expensive.

Is the exchange for me? Yes. If you’ve been denied coverage in the past because of a pre-existing medical condition, the Affordable Care Act (ACA) makes it illegal for you to be denied starting in 2014. All insurers on the exchange will have to sell you a policy regardless of your history. The federal Pre-existing Condition Insurance Plan, which has provided coverage since the ACA passed in 2010, will be shut down as people move over to coverage on the exchange.

What else do I need to know? Insurers are only allowed to ask about four things to figure out your premium: age, where you live, whether or not you smoke and how big your family is. So while medical conditions (past or present) won’t impact your ability to get coverage, a 64-year-old will pay a premium three times that of a 21-year-old and smokers will pay 50 percent more for coverage than non-smokers.

What if I don’t buy coverage? You’ll pay a tax penalty of either 1 percent of your income or $95 per adult and $47.50 per child for the year, whichever is higher. In 2016, the penalty increases to 2.5 percent of income or $695, whichever is higher. Plus, anyone without health insurance will have to pay the full cost of medical care should they need it. You won’t have to pay a penalty for not having insurance if you fall into one of these categories.

  • You qualify for Medicaid but your state didn't expand the program

  • Your state’s health exchange doesn't have a plan you can afford (costs less than 8 percent of earnings)

  • You spent less than three months without coverage

  • You’re a member of a recognized religious group with objections to insurance and government programs, including Social Security and Medicare

    For more on who is exempt visit Healthcare.gov.

Sources: The Kaiser Family Foundation, the U.S. Small Business Administration, Centers for Medicare and Medicaid Services, the U.S. Internal Revenue Service, the Health Insurance Marketplace, U.S. Census Bureau and the UC Berkeley Labor Center.

A version of this story originally appeared on iVillage.


TOP