Options for Health Insurance for Retirees with Pre-Existing Conditions

Many people with employer-sponsored health insurance have a reasonably convenient service with their healthcare needs. Do you get a yearly physical from your doctor? There is no copay. Considering starting a family? Hospital bills are paid for. Several trips to the ER with your daring child? Not a problem: Everything is taken care of.

And now that your children have flown the coop, your working days are nearly over, and you're preparing to retire. You could even be able to retire a few years sooner if you have a good financial plan in place.

However, if you've established a chronic health condition over the years, you may be wondering, "How do I locate health insurance with my pre-existing health condition?"

The definition of a pre-existing condition

A pre-existing condition, according to HealthCare.gov, is a chronic health issue that you had previous to the start date of your new health insurance plan. Asthma, diabetes, and cancer are three examples of pre-existing conditions.

Pre-existing conditions that are commonly encountered

People struggle with a wide range of health conditions, from seasonal allergies to cancer. In reality, an estimated 52 million Americans under the age of 65 have a pre-existing ailment. However, there is no ideal science for establishing what constitutes a pre-existing ailment. In most circumstances, pre-existing conditions are defined by the insurance carrier.

The following is a list of the ten most prevalent pre-existing conditions.

• Acne

• Anxiety

• Diabetes

• Asthma

• Obstructive sleep apnea

• Depression

• COPD

• Obesity

• Atherosclerosis

• Cancer

The list of pre-existing conditions is long. In addition to cardiomyopathy, liver cirrhosis, and dialysis, there is also Parkinson's disease to consider.

You should explore your options, determine whether they meet your health needs, and determine whether you can afford the costs as you figure out how to get medical coverage until you qualify for Medicare.

Pre-existing illnesses and the Health Insurance Marketplace

According to the Affordable Care Act, any plan sold via the Health Insurance Marketplace must cover the following ten essential health benefits:

• Ambulatory patient care (no hospital admittance)

• Services for the disabled

• Inpatient care (for surgical procedures and overnight stays)

• Maternity, pregnancy, and newborn care (before and after birth)

• Substance abuse and mental health problems (includes behavioral health treatment)

• Prescription medications

• Services for rehabilitation and rehabilitation (includes devices)

• Services for laboratories

• Services for prevention and well-being

• Services for children (includes oral and vision)

In some circumstances, these ten advantages go above and beyond the call of duty: After all, it's doubtful that senior individuals will need pregnancy and pediatric services.

Pre-existing conditions are protected by the Affordable Care Act.

The Affordable Care Act makes it illegal for qualifying health plans to deny you coverage because of a pre-existing condition. You cannot also be charged more because of a pre-existing condition, however, you can be charged more if you smoke.

A grandfathered individual insurance policy was the only exception to the pre-existing coverage provision. A grandfathered individual insurance coverage is one that you or your family purchased before March 23, 2010.

Options when you near the Medicare eligibility age

But what if an ACA plan isn't the best option for you? Perhaps you missed the open enrollment period, or you have studied the ACA plans and are dissatisfied, or you have a variety of other reasons why you do not want to purchase a plan through the Marketplace. So, what's next? Always keep in mind that you have options.

Health insurance for the short term

Short-term health insurance policies protect you in the case of an unforeseeable accident or illness. Most plans provide extensive provider networks or allow you to see any doctor you want. They cover things like urgent care, emergency department visits, hospitalizations, laboratories, and x-rays. People with pre-existing ailments, on the other hand, maybe denied coverage by insurance carriers.

When you apply for a short-term health plan, health insurance firms may ask you medical questions to ensure you're a good fit for this sort of coverage. Insurance companies may inquire whether you have previously been rejected insurance owing to a health issue, or if a doctor has urged you to have medical tests but you have yet to do so. You may also be questioned if you have had any previous medical difficulties, such as cancer or hepatitis.

The questions differ for every firm, but you should anticipate answering a few before moving on with your application.

Health insurance for retirees

Some firms provide retiree health insurance as a perk. Even if you're retired, you're still labeled as an active employee receiving health coverage under the company's existing policy. You are usually covered for a specific amount of time, or until you qualify for Medicare. Though not as widespread as it once was, some employers still provide this benefit. Check with your employer's human resources department to see if this is a possibility.

COBRA insurance coverage

If your employer does not provide retiree health insurance, you may be able to rely on the Consolidated Omnibus Budget Reconciliation Act, also known as COBRA. This rule permits you to prolong your active employee health care plan for a predetermined period, typically up to 18 months.

Most companies pay a significant amount of the coverage costs for their current employees. However, if a person quits, the cost of the plan is passed on to the former employee. This means you may be obliged to pay the full cost of the plan, plus a 2% administrative fee. Companies with 20 or more employees in both the private and public sectors often offer COBRA.

Coverage provided by your spouse

The solution to obtaining health insurance may be right under your nose — or, at the very least, living in the same house as you. If your spouse is still employed, look into joining his or her health plan. It is most likely the simplest and most cost-effective solution. Even if you and your spouse retire at the same time, your spouse's job may provide retiree medical care. You may also be qualified for coverage under that plan.

Purchase private insurance.

You can find a private insurance carrier near you by searching online. You might be able to get a plan that meets your health and medical demands without breaking the bank or committing to a longer duration than necessary.

Also, look into professional organizations: Did you belong to any that are linked to your profession? These groups may also provide financially feasible plans.

The marketplace created by the Affordable Care Act

One goal of the ACA was to make health insurance available to anybody who needed it, regardless of financial situation, age, or health status – including those with pre-existing diseases. As various people require varying degrees of coverage, plan types and rates on the marketplace will vary. For individuals who qualify, tax credits are available to help offset the expense.

Concierge medicine/direct primary care

Direct primary care, often known as concierge medicine, is a novel way to obtain health care without having health insurance. This is how it works:

Direct primary care practices charge a monthly fee for comprehensive access to primary care services on demand, rather than charging by the office visit or procedure/treatment The monthly fee varies according to the scope of services desired, but more services usually cost more.

Direct primary care enables doctors to provide certain medical services to their patients that an insurance company may not permit. Some of these services include same-day appointments, 24-hour access, short wait periods, and even house calls. However, there are significant disadvantages to concierge medicine and direct primary care.

• The monthly fees paid to concierge doctors constitute the practice's financial backbone. Some doctors may be tempted to limit the care they provide, although this is not always the case.

• Patients who require higher-level treatments that go beyond the menu provided by the practice's monthly charge may incur higher out-of-pocket expenses. This is especially true for those who have pre-existing medical issues.

• Direct primary care enables clinicians to spend more time with each patient, which is beneficial. However, this means fewer open appointments and a smaller patient list, making it difficult to locate a direct primary care provider who accepts new patients.

• Most significantly, this is not insurance and does not cover hospitalization.