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Is being 50 a pre-existing condition?

Meadmaker

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Meadmaker
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Apr 27, 2004
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I haven't followed the health care debate closely. At some point, I realized that the final bill would be a bunch of compromises and backroom deals and whatever else had to be done to get the required number of votes. It didn't seem likely that my knowledge would have much effect.

Now, though, the bill is almost done, and one thing that everyone agrees will be in it is that insurance companies will not be able to deny coverage based on a preexisting condition.

So, does anyone know what that means exactly? We all understand that some people are more likely to need expensive health care than others. Can insurance companies set premiums based on the presence or absence of those conditions? While they aren't allowed to deny coverage, can they set higher premiums if they know that preexisting conditions are present? If so, there's no point in having the provision at all, because the insurance company could just set the premium at a realistic estimate of what it would really cost to cover this person's health needs, which would make it like not having insurance at all. If not, then are they required to charge the same for a healthy 21 year old that they would for a fat, flabby, guy pushing 50 with high cholesterol? (Not that I know anyone like that, mind you. I'm just speaking hypothetically.)

So, what can you do based on preexisting conditions, and are "conditions" just diseases, or do they include other attributes, like age or risk factors?
 
I bet upon reaching 50, any insured will be penalized/dropped for a "predictable condition". :)
 
They can't deny or charge more for pre-existing conditions AFAIK, but if I'm understanding it correctly they can charge 3 times as much for older people?

If they did this right everyone would be charged the same for the same policy, that's what the whole insurance thing is supposed to do if they treat everyone as being in the same group.

And to pre-emptively head off the usual responses to this, does your employer deduct more from the paycheck of older workers for their premium co-pay than the younger ones?
 
Well basically some of us will have to pay a higher amount for coverage or pay a fine. Given that the fine is lower than the coverage, I guess some of us will just be forced to pay a fine. It is awesome. I love the idea of being given a penalty because some (rule 10) bean counter decided that I should be fined for heart problems.

Chains we can believe in.

EDIT: I am upset with the bill, and I don't want to appear partisan. I don't see this helping with the situation my father dealt with. Being on Tricare and still having to declare bankruptcy after his heart attack. I have the same issue, and I am screwed under this plan.
 
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As it stands right now if you have cancer or a broken leg and are trying to get insurance, insurance companies will deny coverage for your cancer or broken leg. Sometimes they will allow coverage after you have been insured with them for a preset length of time (years). A pre-existing condition is a health problem that has been diagnosed prior to getting insurance. The reason why they didn't allow coverage for pre-existing conditions is that people would never get insurance till they needed it and insurance companies would have to charge a lot more for insurance to make up for that. Now with universal health care it needs to be universal so everyone needs to be covered.
 
Under Hipaa, which I guess won't apply now if the new bill is passed, a PEC is anything you've seen a doctor for in the last 6 months.

A new insurer can exclude PECs for 12 months maximum, and only if the PEC was not covered under an older plan for the past 12 months (or if you go 63 days or longer without any insurance in between switching).
 
I'm fairly familiar with current definitions, but I wasn't sure about under the new bill.

I know that we are all supposed to get health insurance under the proposed plan, and I think that's fine, but I'm guessing we aren't all required to get the same level of coverage. Is there anything in the new bill that prevents me from switching providers from relatively low coverage to relatively high coverage, after I get sick.

Also, under the new rules, I understand they can't turn you down for "preexisting conditions", but can they charge you a gazillion dollars per year in premiums?

In an extreme case, consider the possibility that someone is dissatisfied with their insurance carrier due to lousy service, and so they want to switch, And, they happen to be in intensive care at the time, because they had a massive heart attack and have a bypass scheduled for next week?
 
Meadmaker said:
I'm fairly familiar with current definitions, but I wasn't sure about under the new bill.

I know that we are all supposed to get health insurance under the proposed plan, and I think that's fine, but I'm guessing we aren't all required to get the same level of coverage. Is there anything in the new bill that prevents me from switching providers from relatively low coverage to relatively high coverage, after I get sick.

Also, under the new rules, I understand they can't turn you down for "preexisting conditions", but can they charge you a gazillion dollars per year in premiums?

In an extreme case, consider the possibility that someone is dissatisfied with their insurance carrier due to lousy service, and so they want to switch, And, they happen to be in intensive care at the time, because they had a massive heart attack and have a bypass scheduled for next week?
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A far bigger weakness of the bill is that the penalty for not buying insurance is about 25% of what buying insurance would cost you.

So why not just go without, pay the penalty, and buy the insurance (which they have to sell you) when you get sick?

And no, they can't charge you extra for this.
 
WildCat said:
So why not just go without, pay the penalty, and buy the insurance (which they have to sell you) when you get sick?

And no, they can't charge you extra for this.
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There must be something more to this. The insurance companies, apparently, love this bill. (At least, I heard Bernie Sanders saying they were going to make out like bandits.) If the above were completely accurate, they ought to hate this bill.

What am I missing?
 
Meadmaker said:
There must be something more to this. The insurance companies, apparently, love this bill. (At least, I heard Bernie Sanders saying they were going to make out like bandits.) If the above were completely accurate, they ought to hate this bill.

What am I missing?
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How many uninsured americans right now, 30 million or so? The health care bill requires them to get insurance. Even if some still don't buy insurance, many will. That's a whole lot of new customers for the insurance companies.
 
KSskeptic said:
How many uninsured americans right now, 30 million or so? The health care bill requires them to get insurance. Even if some still don't buy insurance, many will. That's a whole lot of new customers for the insurance companies.
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But according to Wildcat, and Wildcat is simply repeating a very common complaint, you can pay 1/4 the cost of the insurance to the government until you actually get sick, and then you can start paying the full cost to the insurance company.

If that's really the case, it would be an extremely bad bill for the insurance companies. I have to believe I'm missing something.
 
Meadmaker said:
But according to Wildcat, and Wildcat is simply repeating a very common complaint, you can pay 1/4 the cost of the insurance to the government until you actually get sick, and then you can start paying the full cost to the insurance company.

If that's really the case, it would be an extremely bad bill for the insurance companies. I have to believe I'm missing something.
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They don't care, they'll just jack up the premiums. What they didn't want was competition, and Congress did their bidding on that score.
 
WildCat said:
They don't care, they'll just jack up the premiums. What they didn't want was competition, and Congress did their bidding on that score.
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I guess we'll find out. Seems a bit strange to me, but the Senate has passed a bill, so unless something completely falls apart in the reconcilliation process, there will be significant changes ahead.

If things are as you say they are, it's an unsustainable model, but of course, there are a few years before anything even kicks in. Who knows what will really happen between now and then?
 
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