How will the ban on denials for pre-existing conditions work?

[jasg]

@Saint_Cad

I asked this a week ago and basically it was “assume everyone has insurance…” I wonder what happens to people who are heathy so pay the fine THEN get sick.

The bill appears to have provisions for waiting periods and open enrollment times. This is nothing new, it is just like Employer insurance plans and Medicare. For employer plans, you can only make changes during open enrollment and typically, there are waiting periods after initial enrollment for coverage on pre-existing conditions.

For Medicare, you have to enroll when you first become eligible, if you do not do this - you wait until the next January for open enrollment.

It would appear to me that if you choose to pay the fine instead of enrolling, then get sick. You wait (and pay all medical expenses) until the next open enrollment period. Depending on how your state exhange and insurance companies decide to do business, there may be an additional waiting period for coverage of pre-existing conditions - but they cannot outright reject you.

I’m sure that the authors of the legislation considered the opportunities for ‘Gaming’ the system by buying cheap insurance or waiting to buy it and have put (or will allow) safeguards against it.

Still though, as with everything else in life - people will choose to roll the dice - and the rest of us will pay their medical expenses with higher premiums - just as we do now.

[The_Great_Philosopher]

@jasg

The bill appears to have provisions for waiting periods and open enrollment times. This is nothing new, it is just like Employer insurance plans and Medicare. For employer plans, you can only make changes during open enrollment and typically, there are waiting periods after initial enrollment for coverage on pre-existing conditions.

Does it? What are they? I’ve never heard of such provisions.

It would appear to me that if you choose to pay the fine instead of enrolling, then get sick. You wait (and pay all medical expenses) until the next open enrollment period. Depending on how your state exhange and insurance companies decide to do business, there may be an additional waiting period for coverage of pre-existing conditions

As far as I’m aware there’s no additional waiting periods for pre-existing conditions. There’s no discrimination based on pre-existing conditions whatsoever.

I’m sure that the authors of the legislation considered the opportunities for ‘Gaming’ the system by buying cheap insurance or waiting to buy it and have put (or will allow) safeguards against it.

Again, as far as I’m aware, they haven’t really. The legislators figure that people like having affordable insurance when its available and they don’t like paying large fines, so they’ll buy insurance. That’s about it. The CBO mostly agrees. But they could be wrong. In answer to Saint Cad, I don’t know the specifics of enrollment or applying for insurance, but the basics are that if you are uninsured by choice and paying fines, and you come down with a serious illness, you apply for insurance with an insurance company and they have to offer you insurance, at the normal premium levels, and they thus have to pay for your treatment. Is this what you meant?.