The Changes or Lack of Changes in Health Insurance

A Few Facts About Health Insurance Pre & Post 2020 Presidential Election. Mark Dupre and the MLD Agency have seen their share of different Presidents and many changes in the health insurance industry. No matter how much things change Mark still looks at everything through his client’s eyes and has their interest in mind.

Like many elections’ healthcare, the Affordable Care Act, health insurance, and pre-existing conditions are main topics of discussion with each opponent standing on the completely opposite side when it comes to how healthcare and health insurance should be handled. The big difference we hear much about has to do with whether one or the other supports the coverage of pre-existing conditions.  What many don’t fully understand is the pre-existing condition is ALWAYS covered especially when individuals take matters into their own hands and ensure they have coverage their entire lives. Now this is not what you seem to hear when there are debates and you hear differently in each commercial. So what does all the pre-existing condition controversy mean?

What are the 10 Essential Benefits?

In order to fully understand what they are all talking about we first need to understand what the Affordable Care Act does. The main purpose of this Act is to make sure every person has and every plan covers 10 Essential Benefits. Now, what are these 10 Essential Benefits you ask? Well, they are simply listed below.

1. Hospitalization: All treatment you receive in the hospital as an inpatient must be covered. Plans may limit coverage for extended stays.
2. Ambulatory Patient Services: This is outpatient care you receive without being admitted into the hospital while you are in the ambulance or cared for by EMTs at a residence.
3. Pregnancy, Maternity, & Newborn Care: These are services that care for you and your baby before, during, and shortly after giving birth.
4. Pediatric Services: This includes dental care, vision care, well-child visits, vaccines, and immunizations. Dental and vision care must be offered to children through the age of 18 (two routine dental exams; one yearly eye exam with corrective lenses).
5. Prescription Drugs: The federal government has categorized approved prescription drugs. One from each category must be covered.
6. Preventive & Wellness Services & Chronic Disease Management: Includes services such as diet counseling, colorectal cancer screening, Type 2 diabetes screenings, and immunization vaccines.
7. Emergency Services: Basically, this is a trip to the emergency room where you truly need care as soon as possible. This also means that you won’t be penalized if the hospital is out of network.
8. Mental Health & Addiction Services: This includes services to treat behavioral health, provide counseling, or provide psychotherapy.
9. Rehabilitative & Habilitative Services & Devices: These services help you recover if you are injured, have a disability, or have a chronic condition. Services may include physical therapy, occupational therapy, or speech therapy.
10. Laboratory Services: This includes testing to diagnose, gauge effectiveness, and some preventive screenings.

The truth is these types of services have always been offered in your group and individual plans.

Pre-Existing Conditions – Truths vs. Myths

Now we move on to diving a bit deeper into the issue surrounding pre-existing conditions. The truth about pre-existing conditions is that they have been covered since 1995 by both your Group benefits and individual plans. Before 1995 most people did what, they were supposed to and purchased and stayed on health insurance from the time they were taken off their parents which meant they had insurance since they were healthy. This is key, if you have group health insurance through an employer, they always cover pre-existing conditions, and when you leave that employer you are also able to gain insurance benefits even if you developed a condition while on the other. Switching over gives you a guaranteed issue.

So, what did the ACA do then? Well, it made parameters that you have to fit into in order to be eligible for their plans and if you do not fit in these categories you can only purchase temporary insurance that covers you for 180 days; that’s only 6 months! The ACA also increased premiums across the board. Some of my clients saw 4’x an increase and I have some clients that saw 10 times an increase in premiums since the ACA in 2016. As an agent, I feel I do not have the ability to offer you as many cost-effective plans that fit customized needs.

The bottom line is it doesn’t matter how we vote. I hope you stand behind your vote and yet stay informed. The MLD will continue to educate you on current news, laws, and policies that will affect you and your health and life insurance benefits.

Contact the MLD for your insurance needs.