# Obamacare: why aren't people with pre-existing conditions signing up ? **URL:** \ **Category:** Factual Questions\ **Created:** [November 16, 2013, 6:05pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067 "2013-11-16T18:05:16Z")\ **Posts on this page:** 13\ **Page:** 3
**Author:** ![Inner\_Stickler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/inner_stickler/32/318_2.png) [@Inner\_Stickler](https://boards.straightdope.com/u/Inner_Stickler)\ **Post date:** [November 18, 2013, 4:18pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/41 "2013-11-18T16:18:39Z")
> [@healthcare.gov](#): > > In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event. Qualifying life events that create a special enrollment period include: > > Getting married > Having, adopting, or placement of a child > Permanently moving to a new area that offers different health plan options > Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.) > For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions I don’t care enough to research any further. If you want to risk that a car accident or cancer diagnosis will count as a qualifying life event, you can. I wouldn’t care to do so, though. ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 18, 2013, 4:55pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/42 "2013-11-18T16:55:45Z")
> [@Athena](#): > > Really? Comparing the Obamacare plans to what I paid for insurance when I was self employed, the Obamacare is better. Not by a ton, but enough that it would make sense for me to change. I’m surprised to hear that you got it cheaper pre-Obamacare. Yeah, really. For a similar plan, the ACA premium is 90% higher. $1,188 per month. And before anyone chimes in that I have a “lousy” plan, that’s not true. My plan matches up most closely with a “gold” ACA plan. I even have no lifetime maximum with my current plan. ---
**Author:** ![Diceman](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Diceman](https://boards.straightdope.com/u/Diceman)\ **Post date:** [November 18, 2013, 5:15pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/43 "2013-11-18T17:15:31Z")
> [@Athena](#): > > Really? Comparing the Obamacare plans to what I paid for insurance when I was self employed, the Obamacare is better. Not by a ton, but enough that it would make sense for me to change. I’m surprised to hear that you got it cheaper pre-Obamacare. It may be cheaper, but how does the coverage compare to your old plan? I’m going to be saving money next year, but the coverage isn’t nearly as good. What I currently have almost certainly equates to a gold-level plan. We don’t have any comparable option for next year, and the most expensive (ie, least worse) option costs more than what pay now. I’m going with a lower option, because if I have to accept higher out-of-pocket costs, I want to get lower premiums as a trade-off. ---
**Author:** ![Quercus](https://avatars.discourse-cdn.com/v4/letter/q/7ab992/32.png) [@Quercus](https://boards.straightdope.com/u/Quercus)\ **Post date:** [November 18, 2013, 9:34pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/44 "2013-11-18T21:34:19Z")
> [@Orwell](#): > > Yeah, really. For a similar plan, the ACA premium is 90% higher. $1,188 per month. And before anyone chimes in that I have a “lousy” plan, that’s not true. My plan matches up most closely with a “gold” ACA plan. I even have no lifetime maximum with my current plan. I’m honestly confused: does your current plan meet ACA requirements? If so, then you just stay on it, right? No premium increases for you. If it’s missing required things, then the ACA plans aren’t really comparable are they? ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 18, 2013, 11:33pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/45 "2013-11-18T23:33:33Z")
> [@Quercus](#): > > I’m honestly confused: does your current plan meet ACA requirements? If so, then you just stay on it, right? No premium increases for you. > > If it’s missing required things, then the ACA plans aren’t really comparable are they? My current plan does not cover pregnancy, which is not a problem as we’ve already had our kids. I believe our plan also isn’t ACA-conforming regarding mental health coverage. I know it has no lifetime maximum, as that was removed a couple of years ago. I’ve been notified that I can keep my plan through 2014 but it will then be eliminated. I looked at the ACA plan thinking I might find an alternative, but none are remotely affordable to me. I can’t understand how the pregnancy and mental health coverages translate to a 90% increase. ---
**Author:** ![Space\_Vegetable](https://avatars.discourse-cdn.com/v4/letter/s/6de8d8/32.png) [@Space\_Vegetable](https://boards.straightdope.com/u/Space_Vegetable)\ **Post date:** [November 19, 2013, 4:16am UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/46 "2013-11-19T04:16:58Z")
> [@Orwell](#): > > My current plan does not cover pregnancy, which is not a problem as we’ve already had our kids. As noted, such coverage could also be useful if your kids are under 26, still on your plan, and might be having additional kids themselves. > [@Orwell](#): > > I can’t understand how the pregnancy and mental health coverages translate to a 90% increase. Perhaps your old coverage was medically underwritten, excluding those more likely to get sick, and the carrier for your new coverage (not medically underwritten) is scared they might get lots of sick people, so they’re starting with very high rates until they see. (They’ll have to refund some money if their payout estimates are way off; they can’t just keep all of it as profit.) I’ll sign up as soon as the ACA web site is fixed, or by phone if it’s still too buggy by early December. My group health coverage is going away, and comparable coverage from the same insurance carrier via the marketplace web site should save me a few thousand dollars a year, without getting any subsidy. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [November 19, 2013, 4:49am UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/47 "2013-11-19T04:49:50Z")
> [@Athena](#): > > … > > This concept gets a lot of press, but I’m not sure it’s true. First off, I’m pretty sure that in a few years, the penalties will be high enough that it will be cheaper to get a low-level plan. … Actually, after 2016 the penalty is indexed to cot of living. But insurance premiums have consistently outpaced inflation. So as the years go by there will be a stronger and stronger incentive to not participate and just pay the fine. [Cite](http://www.forbes.com/sites/theapothecary/2013/08/28/white-house-publishes-final-regulations-for-obamacares-individual-mandate-seven-things-you-need-to-know/)(skip to item 3) ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 19, 2013, 1:06pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/48 "2013-11-19T13:06:22Z")
> [@Space\_Vegetable](#): > > Perhaps your old coverage was medically underwritten, excluding those more likely to get sick, and the carrier for your new coverage (not medically underwritten) is scared they might get lots of sick people, so they’re starting with very high rates until they see. (They’ll have to refund some money if their payout estimates are way off; they can’t just keep all of it as profit.) It absolutely was medically underwritten, and we fought to get one family member changed from Tier 2 to Tier 1 to save some money. They refused to change another member from Tier 2, so he (one of my sons) has his own policy. It only costs $87 a month; the new ACA charge for him is $144. So, even though he is rated as higher risk than the rest of my family, the ACA premium for a similar policy is still 66 percent higher. I’m guessing the insurance companies are “guessing” with extremely high rates so they don’t take a bath during the first year. At least I’m hoping that’s the case before I have to sign up next year. ---
**Author:** ![alphaboi867](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alphaboi867/32/3898_2.png) [@alphaboi867](https://boards.straightdope.com/u/alphaboi867)\ **Post date:** [November 19, 2013, 10:49pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/49 "2013-11-19T22:49:19Z")
> [@Space\_Vegetable](#): > > As noted, such coverage could also be useful if your kids are under 26, still on your plan, and might be having additional kids themselves… Maternity coverage for a dependent daughter isn’t necessarily the same as maternity coverage for the policyholder or the policyholder’s wife. It’s not uncommon for insurance to only cover the latter and not the former; in which case your only options are to get your daughter her own policy or on Medicaid. It’s not something that even occurs to most people to ask about until they get a claim denied and AFAIK it’s not something the ACA changed. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [November 20, 2013, 12:06am UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/50 "2013-11-20T00:06:45Z")
> [@doreen](#): > > You didn’t start from the beginning-there are a lot more than 500 high or college- aged daughters covered on their over- 50 parent’s policies. And those parents need the coverage as much as the thirty year old couple does. You know that the children of these under 26-year-old dependents aren’t covered by grandma and grandpa’s policy, right? ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [November 20, 2013, 12:09am UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/51 "2013-11-20T00:09:14Z")
> [@alphaboi867](#): > > Maternity coverage for a dependent daughter isn’t necessarily the same as maternity coverage for the policyholder or the policyholder’s wife. It’s not uncommon for insurance to only cover the latter and not the former; in which case your only options are to get your daughter her own policy or on Medicaid. It’s not something that even occurs to most people to ask about until they get a claim denied and AFAIK it’s not something the ACA changed. I hadn’t considered that, but looking around, I can’t find anything specific about dependent maternity coverage and small group or individual plans. There’s a lot of information about requirements for maternity coverage, much about a loophole where employer plans covering more than 15 people were required to provide maternity benefits pre-ACA\* but only to the employee and spouse , and reports of complaints filed against employers alleging that excluding dependent daughters from maternity coverage violates a section of the ACA which bars sex discrimination ( even though it doesn’t violate the Pregnancy Discrimination Act) Pregnancy is the only issue I can think of that might be covered for policyholders but not dependents, and the lack of specific information about such an exclusion makes me think ACA does require dependent maternity coverage in individual plans. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [November 20, 2013, 12:40am UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/52 "2013-11-20T00:40:58Z")
> [@doreen](#): > > I hadn’t considered that, but looking around, I can’t find anything specific about dependent maternity coverage and small group or individual plans. There’s a lot of information about requirements for maternity coverage, much about a loophole where employer plans covering more than 15 people were required to provide maternity benefits pre-ACA\* but only to the employee and spouse , and reports of complaints filed against employers alleging that excluding dependent daughters from maternity coverage violates a section of the ACA which bars sex discrimination ( even though it doesn’t violate the Pregnancy Discrimination Act) > Pregnancy is the only issue I can think of that might be covered for policyholders but not dependents, and the lack of specific information about such an exclusion makes me think ACA does require dependent maternity coverage in individual plans. > **[Advocacy Group Seeks To Force Employers To Give Pregnancy Coverage To...](https://kffhealthnews.org/news/complaints-about-sexual-discrimination-on-daughters-pregnancy-benefits/)** > > The National Women's Law Center files complaints with HHS alleging that five institutions discriminate against women by excluding pregnancy coverage from the health insurance benefits that they provide to employees' daughters. [http://www.washingtonpost.com/national/health-science/parents-insurance-covers-children-up-to-age-26--but-not-for-pregnancy/2012/08/06/2b59f160-6a2c-11e1-acc6-32fefc7ccd67\_story.html?hpi](http://www.washingtonpost.com/national/health-science/parents-insurance-covers-children-up-to-age-26--but-not-for-pregnancy/2012/08/06/2b59f160-6a2c-11e1-acc6-32fefc7ccd67_story.html?hpi) [http://jezebel.com/5932613/still-on-your-parents-insurance-great-just-dont-get-pregnant](http://jezebel.com/5932613/still-on-your-parents-insurance-great-just-dont-get-pregnant) ---
**Author:** ![Space\_Vegetable](https://avatars.discourse-cdn.com/v4/letter/s/6de8d8/32.png) [@Space\_Vegetable](https://boards.straightdope.com/u/Space_Vegetable)\ **Post date:** [November 20, 2013, 2:57pm UTC](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067/53 "2013-11-20T14:57:08Z")
Those three links back up **Doreen** ’s point. None of them explain the situation with individual or small-group plans, only large-group plans. So they’re not really relevant in a thread on people signing up on the ACA marketplace, since those are all individual plans. It could be the situation is the same for individual plans under the ACA, but I’d like to see a cite on that specific issue, if anyone can find one. [Previous page](https://boards.straightdope.com/t/obamacare-why-arent-people-with-pre-existing-conditions-signing-up/674067.md?page=2)