Health Care MarketplaceNews & Research

The Affordable Care Act Eliminates Coverage Problems for Pre-Existing Conditions

Health insurance companies have never been good to anyone with pre-existing health problems. Most people found the only way they could get health insurance was if they agreed with the insurance company that the problem area would not be covered. In the past, pre-existing conditions meant that it would be nearly impossible to get health insurance. Anyone who has ever been diagnosed with a serious health condition has probably gone to battle with insurance companies at least once. It never seemed to matter how minor the condition was, or how much time had passed since the last time the individual had been effected, most insurance companies refused to cover it, or if they did provide coverage, the policy was so expensive few people could afford it.

The Affordable Care Act eliminates all of that nonsense. No matter what type of health problems you might have experienced in the past, the insurance company MUST provide coverage. The new policy has been very specific. Starting in 2014, American health insurance companies will no longer be able to use pre-existing conditions as an excuse for:

  • Charging higher rates
  • Refusal to provide coverage
  • Partial exclusion from coverage

No More Refusals Based on Family History

Children and grandchildren of people who have struggled with health problems such as diabetes, cardiovascular problems, and cancer know that getting health insurance can be a real struggle. In most cases they were forced to pay an extremely high premium, in other cases they’ve been denied health insurance altogether. The insurance companies in the United States are for profit organizations. They don’t want to insure someone with a family history of health problems because they’re worried that they will lose money if the policyholder develops the same condition.

Under the ACA plan, insurance companies will be forced to set aside their bottom line and cover everyone, no matter what their genetic history might be. The insurance companies will also have to charge a fair rate for the policy.

No More Dropped Policies

Consider this common scenario: A man visits the emergency room when he experiences chest pain and shortness of breath. After conducting tests, doctors determine that the patient has mildly high cholesterol, but the chest pain was likely caused by indigestion, stress, or anxiety. At first, the patient feels relieved. He follows the advice of his doctors and gets some rest and tries to avoid stressful situations. Unfortunately, he later gets a letter from his health insurance company stating that they had decided to drop his coverage since he had been seen for heart problems. To get new coverage would be nearly impossible now that he has a pre-existing condition.

Under the ACA, individuals will be able to go to the emergency room and have immediate health concerns addressed without having to worry about the single appointment resulting in their losing their health insurance.

The ACA promises to eliminate the stress and time individuals with pre-existing conditions and a family history with health problems expended when it came to getting the health insurance they deserved.


Many Preventative Medical Services Will Be Free in the Health Care Marketplace

The medical community has always said that the key to a long and healthy life is diagnosing severe medical conditions as soon as they start to develop and starting appropriately aggressive treatment right away. While several tests and screenings can accurately diagnose severe health problems before they become too severe, many people hesitate to take advantage of these tests because of the high cost.

More often than not some very specific set of conditions have to be met before health insurance companies will approve the tests. If the patient has no symptoms of problems, the insurance company will likely refuse to cover preventative testing. Since most people don’t want to have to pay for expensive tests out of their own pocket, medical conditions sometimes go undiagnosed until it’s far too late.

The Affordable Care Act will change all of that. When it comes to preventative tests and screening for severe medical conditions, insurance companies will be required to cover it all.

Which Preventive Tests and Diagnostic Services does ObamaCare cover?

Help with smoking addiction – Ending a lifelong smoking habit will be the hardest thing you’ve ever done. Having the support of trained counselors will help. By offering the smoking addiction program for free, the government has high hopes that they will be able to eliminate smoking forever.

Mammograms – The numbers indicate that at least one out of every 8 women will develop breast cancer, and the disease causes 40,000 to lose their life every single year. A yearly mammogram will catch the early signs of the cancer developing and take the steps needed to prevent the cancerous cells from spreading.

Some Vaccinations – Vaccinations are an important part of staying healthy. Though all vaccinations will not be free, the government intends to make some, such as tetanus, diphtheria, and pertussis, available at no out-of-pocket expense.

Domestic Abuse Counseling – Domestic abuse impacts more than just the couple. Any children who are involved in the situation will be scarred for the remainder of their lives. Domestic abuse counseling has been designed to stop the cycle of abuse. The entire family will be able to take advantage of domestic abuse counseling at no charge under the rules of ObamaCare.

STD testing and counseling – This will be available to both men and women. Hopefully, by offering this service for free, the spread of dangerous STD’s will be stopped forever.

Breastfeeding Support – New mothers often want to breastfeed their newborn babies, but they’re not always sure how to go about it. Now they will be able to get free breastfeeding support, counseling, and the necessary supplies.

Birth Control Contraceptives – While it’s true that some types of birth control will be available for free, it’s important to note that this won’t be true of all brands. If the brand you use isn’t listed as one of the free ones the ObamaCare program covers, you’ll want to talk to your doctor about a different brand which will work just as well and can be used for free.

Being able to utilize all of these free medical services should cause the average American’s overall health to improve.




The Affordable Care Act Eliminates the Doughnut Hole

As part of the new Affordable Care Act (ACA), the legislation manages to reinvent health care but also significantly reduce the doughnut hole gap that has plagued the Medicare program and put a great deal of strain on senior citizen’s finances which were already stretched thin.

What is the Doughnut Hole?

Lots of people had a Medicare drug plan that has a coverage gap which triggers something experts have dubbed the doughnut hole effect. Instead of having a set amount you have to pay for your drugs each time you fill a prescription, Medicare agrees to cover the cost, but only up to a point. Once you have exceeded the amount that Medicare agreed on covering, you’ll be responsible for covering the rest of your monthly prescription bill, creating all kinds of stress and problems if you’re already on a fixed income and don’t have much extra pocket money each month and your doctor has just put you on a new and expensive medication.

The worse part of the situation is that many of the senior citizens don’t even know that they’re going to have to pay more for their prescription drugs until they get their Explanation of Benefits, which is sent out monthly. The letter shows how much you’ve spent on prescription medications, and how much available coverage remains before you enter the doughnut hole.

Calculating the rate the doughnut hole gap has expanded since 2003, financial experts predict that if things follow the same line of progression, the gap could cost senior citizens an extra $6,000 each per year by the time 2020 rolls around.

The Doughnut Hole Starts to Close

Rectifying the doughnut holes might very well be one of the best things the Affordable Care Act does.

Some of the financial strain individuals struggling to cope with the doughnut hole gap was relieved in 2012 when the ACA system implemented a change that provided them with a 50% discount on any generic brands of prescriptions they need, and a 14% discount on the name brands. In 2013 the discounted percentages will increase to 52.5 and 21%.

It’s important to note that the doughnut hole won’t go away over night. The way the program has been set up, the hole will gradually close over time. It’s projected that by 2020 the doughnut hole should be completely closed up once and for all.





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