Coronary artery disease, the most common form of heart disease, is the main cause of death in America among both men and women. Just one reason why having heart disease, or any kind of artery or heart problem, used to make it very difficult for individuals to obtain health insurance. Now, regardless of your risk, you cannot be turned down for coverage. Coronary heart disease forms when plaque builds up in the arteries to your heart, and is also referred to as hardening of the arteries. However, there are many other types of heart disease, including angina, myocardial infarction, as well as congenital heart defects. Each of these involves a narrowed or blocked blood vessel, and can ultimately lead to a heart attack, chest pain or stroke if not treated.
As Americans are prone to many of the risk factors, it is no surprise that heart disease is so prevalent. High stress, poor diet, smoking, obesity and sedentary lifestyle are among the many roots of this family of illnesses. They can be treated and prevented by avoiding such behaviors, increasing exercise and eating a balanced diet. If the condition escalates, treatment varies according to the specific type of cardiovascular illness. Many types of heart disease are alleviated by lifestyle changes such as eating habits and also can involve medication. Surgery or other medical procedures may also be required to clear the blockages in the heart, such as a coronary angioplasty, or the more invasive coronary artery bypass surgery.
Health insurers have a history of declining those who are extremely unhealthy, which changed with the health care law. The people who need health care most no longer have the hardest time getting coverage due to these changes. Under the Affordable Care Act, every insurance company is required to accept you for coverage despite your health status and medical history, only increasing your premiums based on how old you are and if you use tobacco. Health problems do not interfere, leaving you the ability to shop for coverage anywhere you like.. If you have any questions about your options for coverage and want to find an affordable plan, call us at 888 803 5917.
Effect of Heart Disease on Insurance: Past and Present
Health Reform & Heart Disease
Any form of heart disease puts you on level ground with the next healthy policyholder under the Affordable Care Act. Individuals with heart problems can get a health plan for the same rate as someone the same age without elimination riders or exclusion periods to prevent access to care. Beginning in 2014, health insurance companies have to follow a new set of guidelines established by the federal government, allowing more people to get covered than ever, especially unhealthy ones. The ACA requires individual health insurers to not increase rates by more than 10 percent each year, which is enforced by insurance regulators and helps to keep prices manageable for any policyholder. The law has also given Americans a new set of preventive care benefits, all of which are free for people with insurance. This includes screenings for diseases for which you might have a high risk. Additionally, essential health benefits required for inclusion with plans on health insurance exchanges and all individual plans make sure your plan covers chronic disease management and wellness.
Many changes have been made to help sick people through the ACA, such as Medicaid expansion, which allows a significantly larger portion of uninsured, low-income Americans to have coverage in certain states. States who decide to expand Medicaid increase the income guideline for parents, and add another group: low-income adults without children earning up to 133-138 percent of the federal poverty line. This will surely help many individuals with heart disease who fall into these categories. More advancements and adjustments have been made to help people without insurance gain it, such as the exchanges and the subsidies offered as coverage itself is mandatory under the health care law. Now that most Americans are covered on equal terms, it will hopefully get easier to receive health care and treat the many illnesses affecting this country.
Heart disease impacted your likelihood of getting health insurance in a fairly negative way before the health care law was effective. Almost 100 percent of the time, you would be declined coverage or if you were lucky, pay twice as much as a healthy person. The majority of health insurers would evaluate your condition based on your BMI (height to weight ratio), which must be within a normal range (below 30), as well as your medical history of surgeries, specific medications, and current treatment. If you took a costly medication, or had any surgery during the look-back period for your state or insurer, you would be turned down.
Previously, health insurance companies had the right to be discriminatory, and only wanted to pay for healthy patients — in other words, as little as possible. Below is an example of a health insurer’s 2012 underwriting guidelines for various diseases of the heart. Though it is evident that most individuals with heart disease would be declined, there were a few groups in there with a bit of hope.
Those who manage their condition with an over-the-counter medication or a prescription drug will be subject to a rate increase, but they may be accepted regardless. Depending on each person’s specific lifestyle choices, current health status, and method of treatment, these are the potential outcomes. For those who do make the cut, there was also the possibility of having one of those exclusion periods or elimination riders accompany your plan. These were the insurer’s way of agreeing to cover you, but not entirely, as you wouldn’t be able to receive coverage for heart problems for a number of months or years. Essentially, these results pushed you into a high-risk pool.
Health Insurance Plans for Heart Disease
Individual health plans are the best way for you to control the amount of coverage you buy and find a premium that works with your budget. Peruse our national carriers to find a health plan that fits your needs with a health insurance quote, or a one-on-one consultation with a licensed agent at 888 503 5917. Or, you can consider some of your other options, including the recently developed exchanges for individuals and small businesses, or the most common outlet with job-based coverage. If your income is insufficient for coverage through a private insurer, you may qualify for Medicaid in your state, depending on your income and what eligibility group you may fall under.
Health Insurance Exchanges
These plans are designed by the Affordable Care Act and sold by private health insurance carriers on a state or federal website. If you have heart disease, there is no way these plan can turn you down for coverage, and each policy in every state includes coverage for managing chronic illnesses. Additionally, hospitalization and ambulatory services are also covered by default. Similar to a private individual plan, the exchange plans feature copays, deductibles and coinsurance, but streamlined into criteria that require all insurers to offer identical products with different networks. This interesting system also offers subsidies to applicants with income between 133 and 400 percent of FPL, reducing the cost of premiums. While it is a new method of selling insurance, the marketplace is helpful for those who can’t afford coverage without such assistance and don’t earn little enough to qualify for Medicaid.
Health plans available through your employer are typically about the same as buying an individual plan on the private market, depending on many variables including inflation and what your employer chooses to cover. Prices can no longer climb for everyone in the group when a person with heart disease joins, as with pre-health reform group plans. No health plan can decline you coverage despite your condition, and you may be able to get your spouse or children covered. While the employer mandate is in place, which requires all large companies over 50 workers to offer a health plan, there isn’t a requirement to cover family members or an abundance of services.
Some group plans will cover an array of medical services, and will perhaps cover a surgery or two as considered medically necessary. If your life is being threatened, the insurer cannot deny a claim. While all coverage is different depending on the chosen plan, you should be able to access the medical care you need on a group plan. The same range of HMO, PPO, and POS applies to group plans as individual plans, so it is much like what you would have been able to get through the individual plan that would be declining you.
If the previous two options are out of your price range, and basically everything seems out of your price range when it comes to insurance, consider Medicaid — if you have not already. The Medicaid program in your state will cover your condition and the basics of medical care for no cost as long as you meet their income guidelines. Each state is different, therefore it is essential you find out what the guidelines are so you can get coverage as soon as possible.
For heart disease or any other condition, they will be accommodating if you fall into an eligibility group such as parent, child, pregnant woman, elderly, or disabled, and in some states just a regular low-income adult. Medicaid does cover some medications, though you should find out which ones are covered by your state’s plan or otherwise get a discount card for heart disease medications. Surgeries and other medical treatments will also be covered by Medicaid programs as they are needed.
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1. U.S. National Library of Medicine. “Coronary Heart Disease”. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/.
2. Mayo Clinic. “Heart Disease”. http://www.mayoclinic.com/health/heart-disease/.