Obamacare’s next open-enrollment period begins on November 1, 2019. As we approach this date, many eyes are watching a federal court case, Texas v. United States, that seeks to invalidate the entire Affordable Care Act. The next decision in the case may come down this fall, creating more confusion about the future of the law.
If the courts eventually overturn the ACA, almost 20 million Americans stand to lose their health insurance. Without a new law in place, many would lose coverage because of preexisting health conditions. (Preexisting conditions include illnesses like cancer, asthma, epilepsy, and diabetes. The list also includes mental illnesses such as depression or anxiety, and may extend to ordinary life experiences like acne or pregnancy.) Those with preexisting conditions who don’t lose their coverage outright could contend with sky-high premiums and unmanageable out-of-pocket costs.
ACA Protections for People with Preexisting Conditions
Here are seven important ways the Affordable Care Act protects people with preexisting conditions:
- Insurers can’t deny you health coverage. The ACA’s “guaranteed issue” provision means that insurers must offer health plans to every applicant, without considering their health status or other factors.
- Insurers can’t use your health status to raise your premiums. The ACA’s “community rating” rule prevents insurance companies from setting premiums within a geographic area based on age, gender, race, health status, or other factors.
- Insurers can’t deny you the services you need to treat preexisting conditions. The Affordable Care Act says that health insurers can’t limit or deny services based on the fact that you have a health condition that was present before your coverage started.
- Additional protections for people who get insurance through their job. Many safeguards for folks with job-based insurance existed before the ACA, but the ACA expanded these protections. First, large employers must provide a minimum package of health benefits, and they may not place limits on the amount of benefits you receive. In addition, you can get individual coverage if you leave your job, even if you have a preexisting condition.
- Insurers must offer you a full benefits package. Under the ACA, insurance plans must cover ten essential health benefits. (But see how the Trump Administration has eroded this part of the law by creating a loophole for skimpy, short-term plans.)
- Insurers can’t ask you to pay more than a certain amount for care each year. The ACA puts a cap on the amount you have to pay out of pocket each year.
- Insurance plans must include free preventive services. For a list of these services, see Understanding Obamacare’s Preventive Health Care Benefits.
More Information
To learn more about the benefits of health insurance plans offered under the ACA, see What Do Obamacare Health Plans Cover?
For information about finding affordable health insurance in your state, visit Legal Consumer’s Obamacare learning center.
