Q. My husband and I have health care through his job. I’m 59 and he’s 60 and we both have pre-existing conditions. He plans to retire in 2018 and we would have to buy health insurance. Does it make sense to buy now while we know pre-existing conditions are covered under ACA? This way we would have a lower premium than if ACA is repealed, correct?
— Planning ahead
A. Thank you for such a great question. It brings up several important issues, not just pre-existing conditions.
The Affordable Care Act (ACA), also known as Obamacare, eliminated the pre-existing condition clause in insurance contracts.
This means anyone with a pre-existing condition, like you and your husband, would be covered for those conditions from day one, said Ed Gaelick, a Chartered Life Underwriter and Chartered Financial Consultant with PSI Consultants in Glen Rock.
“The law also realized that could lead to individuals jumping in and out of the `system’ only when they needed care, so the ACA also created `open enrollment’ periods,” Garlick said. “Basically you can’t just purchase insurance any time you wanted.”
You would need to wait for an open enrollment opportunity.
Open enrollment could be when you are initially eligible for a company-sponsored plan, which Gaelick said would be that company’s annual anniversary date with their insurance carrier. Or it could be Nov. 15 to Dec. 15 for a Jan. 1 effective date in the individual market. Or it could be when someone loses coverage involuntarily, gets married, has or adopts a child or initially becomes eligible for COBRA or State Continuation, Gaelick said.
“So if your husband retires and is currently covered by his employer’s group plan, that would create an opportunity to 1) shop the individual market for new coverage that would have no pre-existing condition clause, or 2) stay on the group plan under COBRA/State Continuation for up to 18 months,” Gaelick said.
Because he isn’t going to be age 65 in 2018 when he’d become eligible for Medicare, both options are available.
“If he chooses continuation, he still won’t be 65 once continuation ends in 18 months so that would be an involuntary loss of coverage and he could get individual coverage at that time, during a special open enrollment period,” Gaelick said. “Once he becomes 65, Medicare plus supplements would be an additional option for him.”
For now, the ACA is here and the rules are in place.
Gaelick said it seems incredibly remote that any repeal or replace or significant change would eliminate the popular pre-existing condition clause.
So when you ask if it makes sense to buy now, yes, buy now, Gaelick said, but only because you don’t want to be uninsured for even a day.
He said to guess on repeal or future premiums would be that — a pure guess.
Gaelick said he believes premiums would be lower if a repeal created more competition in the markets, and the reality is that carriers are dropping out of the markets.
“So no crystal ball, but the takeaway should be to maintain coverage now, regardless of what coverage, and you and everyone else will make adjustments as things change, if necessary,” Gaelick said.
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