Health Insurance Options for Retirees with Pre-Existing Conditions
Health Insurance Options for Retirees with Pre-Existing ConditionsIf you've had employer-provided health insurance throughout your career, you've likely had a fairly smooth experience when it came to your healthcare needs. Yearly physical with your doctor? No copay. Starting a family? Hospital bills covered. Numerous ER visits with your daredevil child? No problem: All covered. And now that your kids have flown the coop, your working days are almost over, and you're getting ready to retire. You might even be able to call it quits a few years early if you've had a solid financial plan in place. But if you've developed a chronic health condition over the years, you may have one lingering question: How do I find health insurance with my pre-existing health condition? Defining a pre-existing condition According to, a pre-existing condition is a chronic health issue you've had prior to the date that your new health insurance plan starts. Asthma, diabetes, and cancer are three examples of conditions that could be pre-existing. Common pre-existing conditionsPeople deal with all sorts of health issues ranging from seasonal allergies to cancer. In fact, an estimated 52 million Americans age 65 and under have a pre-existing condition. But there's no perfect science to determining what, exactly, qualifies as a pre-existing condition. In most cases, the insurance company defines pre-existing conditions.Here’s a list of the 10 most common pre-existing conditions.AcneAnxietyDiabetesAsthmaSleep apneaDepressionCOPDObesityAtherosclerosisCancerBut the list of what insurance companies view as a pre-existing condition is long. Some of the more life-threatening health problems include cardiomyopathy, cirrhosis of the liver, dialysis, and Parkinson’s disease.So as you figure out how to find medical coverage until you qualify for Medicare, it's worth it to research your options, how they fit your health needs, and whether or not you can afford the costs.The Health Insurance Marketplace and pre-existing conditionsThanks to the Affordable Care Act, any plan offered on the Health Insurance Marketplace must include these 10 essential health benefits:Ambulatory patient services (no hospital admittance)Emergency servicesHospitalization (for surgical procedures and overnight stays)Pregnancy, maternity, and newborn care (before and after birth)Mental health and substance use disorder (includes behavioral health treatment)Prescription drugsRehabilitative and habilitative services (includes devices)Laboratory servicesPreventive and wellness servicesPediatric services (includes oral and vision)In some cases, these 10 benefits even extend beyond what's necessary: After all, it's highly unlikely that senior citizens will have much use for pregnancy and pediatric services.Pre-existing conditions covered under the Affordable Care ActThe Affordable Care Act forbids qualified health plans from denying you coverage due to a pre-existing condition. You also can't be charged more due to your pre-existing condition but can for smoking.The lone exception to the pre-existing coverage rule was a grandfathered individual insurance policy. A grandfathered individual insurance policy is one that was purchased for you or your family prior to March 23, 2010.Options as you approach Medicare ageBut what if an ACA plan isn't a good fit for you? Maybe you missed the open enrollment period, or you’ve evaluated the ACA plans and aren’t satisfied, or there are a number of reasons you don't want to purchase a plan on the Marketplace. So what now?Always know that you have options available.Short-term health insuranceShort-term health insurance plans cover you in the event of an unexpected accident or an illness. Most plans offer broad provider networks or allow you to see any doctor you wish. They include benefits such as urgent care, emergency room visits, hospitalizations, labs and x-rays. However, insurance companies can deny coverage to people with pre-existing conditions.When applying for a short-term health plan, health insurance companies can ask you medical questions to make sure you're the right candidate for this type of insurance. Insurance companies might ask whether or not you've been denied insurance in the past due to a health condition, or if a doctor has advised you to have medical tests, but you haven't done them yet. You could also be asked if you have had specific medical issues in the past, such as cancer or hepatitis.The questions vary from company to company, but you can expect to answer a handful of questions before you can proceed with your application.Retiree health insuranceSome employers offer retiree health insurance as a benefit. In this scenario, you're still listed as an active employee who's receiving health coverage under the company’s current policy, even though you're retired. You're typically covered for a set time period, or until you qualify for Medicare. Though not as common as it used to be, some companies still offer this perk. Consult your employer’s HR department to see if this is an option.Coverage under COBRAIf your employer doesn’t offer retiree health insurance, you might turn to the Consolidated Omnibus Budget Reconciliation Act, more commonly known as COBRA. This law allows you to extend your active employee health care plan for a set amount of time, usually up to 18 months.Most businesses pick up a large portion of the coverage cost for their current employees. But once an employee retires, the cost of the plan reverts to the former employee. This means that you may be required to pay the full cost of the plan, along with a 2% administrative fee. COBRA is typically offered by companies with 20 or more employees in both the private and public sectors.Coverage through your spouseThe answer to obtaining health coverage might be right under your nose — or at least living in the same house with you. If your spouse is still working, check into the possibility of joining his or her insurance plan. It’s probably your easiest and most cost-effective option. Even if you both retire at the same time, your spouse’s employer might offer retiree medical coverage. You could be eligible for coverage through that plan as well.Purchase private insurancePrivate insurance carriers, so you can search online for one near you. You can possibly buy a plan that suits your specific health and medical needs without breaking the bank or committing to a longer timeframe than you need.And look into professional organizations: Did you belong to any related to your career? Those organizations might offer financially reasonable plans as well.The Affordable Care Act marketplaceOne goal of the ACA was to make health insurance available to anyone who needed it regardless of financial standing, age, or health status — including pre-existing conditions. Plan types and costs in the marketplace will vary as different people need varying degrees of coverage. Tax credits are available to defray the cost for those folks who qualify.Direct primary care/concierge medicineDirect primary care or concierge medicine is an outside-of-the-box way to get health coverage without purchasing health insurance. Here’s how it works:Rather than charging by the office visit or procedure/treatment, direct primary care practices charge a monthly fee for broad access to primary care services on demand. The amount of the monthly fee varies depending on your desired scope of services, but more services typically come at a higher cost.Direct primary care allows doctors to offer specific medical services to their patients that an insurance company might not allow. Some of those include same-day visits, around-the-clock access, minimal wait times, and even house calls. But there are some drawbacks with concierge medicine and direct primary care.The monthly fees paid to concierge doctors are the financial backbone of the practice. Some doctors could be tempted to limit the care they provide, though this isn't generally the case.Patients requiring a higher level of services, which go beyond the menu covered by the practice's monthly fee, can pay higher out-of-pocket costs. This is especially true for people with pre-existing conditions.Direct primary care allows doctors to spend more time with each patient, which is a good thing. But this also means less available appointments and a smaller patient list, making it difficult to find a direct primary care provider who is accepting new patients.Most importantly, this is not insurance, and does not include coverage for hospital care.As a final thought: Though you have a pre-existing health condition, know that you have choices as an early retiree. Call (866) 664-0504 to speak to a licensed insurance agent, or get a complimentary consultation today.
Answering the Top 20 Common Questions About ACA Health Insurance
Answering the Top 20 Common Questions About ACA Health InsuranceIf you find yourself with questions and confusion about Affordable Care Act (ACA) health insurance, rest assured that you're not alone! As a leading health insurance marketplace, we receive numerous inquiries every day about ACA health insurance. If you have a specific concern, chances are it's addressed as a common question about ACA health insurance in this guide. Continue reading to uncover the answers you seek. The Basics Discover the ACA's mission to provide affordable and accessible healthcare, along with its extensive coverage benefits below. 1. What is ACA and how does it make healthcare more affordable and accessible?ACA makes healthcare more affordable and accessible for everyone. How does it do that? Well, it tackles various issues head-on. For instance, it expands Medicaid so more low-income individuals and families can qualify for the program and receive the care they need. It also creates health insurance marketplaces like ours, where you can easily compare and choose from different plans that fit your budget.2. Is ACA short-term healthcare or long-term healthcare?The great thing about ACA is that its available as a short term healthcare or long-term healthcare option. Whether you're in need of temporary coverage during a transition period or seeking a long-term solution for ongoing healthcare needs, ACA has you covered.3. What health benefits are covered under ACA?ACA ensures health insurance plans cover a range of essential health benefits. These include services like preventive care (think check-ups and vaccinations), prescription drugs, emergency care, hospital stays, mental health and substance abuse treatment, maternity, and newborn care.4. Are there options for dental or vision coverage under ACA health insurance plans?The answer to this common question about ACA health insurance is that many ACA plans offer dental and vision coverage as optional add-ons or as separate standalone plans. This means you have the opportunity to secure comprehensive coverage for not just your medical needs but also for dental treatments and vision care, such as regular check-ups, eyeglasses, or contact lenses.TIP: Our user-friendly online comparison tool can help you find ACA coverage that suits your financial circumstances, health needs, and network preferences. EligibilityFind out if you're eligible for the Affordable Care Act below.5. Who is eligible to purchase health insurance through the ACA marketplace?You're in the right place to find out who can purchase health insurance through the ACA marketplace! Eligibility is based on several factors, and here's a quick rundown to help you figure out if you qualify:U.S. citizenship or lawful presenceResidency in the state where you're applying for coverageIncome within a specific range for your household sizeIneligible for other government health coverage, such as Medicare or Medicaid. Have Questions About Your Eligibility? That's Where We Come In!Call 1-800-314-5594 to speak to a licensed insurance agent.Open weekdays from 8 a.m. to 8 p.m. EST.6. Can I be denied ACA health insurance coverage based on my pre-existing condition?Absolutely not! One of the most significant provisions of ACA health insurance is the protection it offers against being denied coverage based on pre-existing conditions. It's a crucial step toward providing comprehensive and inclusive coverage for everyone.7. Can I get ACA health insurance if I'm self-employed or a freelancer?If you're a gig worker or self-employed, this common question about ACA health insurance is particularly important since you do not have the same benefits as traditional employees. It's designed to provide coverage options for individuals in various work arrangements, including those working independently.8. Are there any special considerations for American Indians and Alaska Natives?This common question about ACA health insurance is very important. If you're an American Indian or Alaska Native, there are indeed special considerations when it comes to ACA. You may be eligible for unique benefits and services through programs like Indian Health Services (IHS), Tribal Health Programs, or Urban Indian Health Programs. These resources provide access to culturally sensitive care, including preventive services, behavioral health support, and specialized treatmentsApplying For ACADiscover the process of applying for ACA and determine if it's the right fit for you in the following section.9. How can I apply for ACA health insurance coverage?Applying for ACA health insurance coverage is easy! To get started, use our user-friendly online comparison tool. It allows you to explore different health insurance plans available in your area and compare their coverage options and costs. You can easily enter your information, such as your location, household size, and income, to see what plans you qualify for and get an estimate of potential subsidies or financial assistance10. Can I apply and qualify for both Medicaid and ACA health insurance at the same time?We receive this common question about ACA health insurance frequently. It's possible to qualify for both Medicaid and ACA health insurance through the marketplace simultaneously. If your income falls within the range to qualify for Medicaid, you'll typically be directed to apply for Medicaid.EnrollmentGet to know the ins and outs of ACA enrollment periods and special circumstances in this section.11. What is the open enrollment period for ACA health insurance plans?The open enrollment period (OEP) for ACA health insurance plans is the designated time when individuals can enroll in or make changes to their health insurance coverage. The next OEP starts November 1, 2023, and ends January 15, 2024.12. Can I get ACA coverage outside of the open enrollment period?If you missed the OEP, don't worry, there are options available to get ACA coverage outside of that timeframe. Special enrollment periods (SEP) exist for individuals experiencing qualifying life events like getting married, having a baby, or losing other healthcare coverage. These periods allow you to sign up for ACA coverage when you experience these qualifying events.13. Can I switch ACA health insurance plans during the coverage year?You typically can't switch plans outside of the annual OEP unless you qualify for a SEP due to a qualifying life event. If you qualify, you can take advantage of the opportunity to switch to a different ACA plan that better suits your needs.14. Can I get retroactive coverage if I missed the deadline for enrolling in an ACA health insurance plan?The answer to this common question about ACA health insurance is that the SEP is your only option to enroll in a plan retroactively, ensuring you have coverage that extends back to the event date; you cannot obtain retroactive coverage during the OEP. It's important to act promptly and contact your health insurance marketplace or our licensed insurance agents to understand the specific requirements and deadlines.Financial Assistance & Tax ImplicationsGet the facts about ACA's financial assistance and tax implications below. 15. What specific subsidies or financial assistance are available to help lower the cost of ACA?Premium tax credits and cost-sharing reductions are available to lower the cost of your ACA health insurance. Premium tax credits help lower-income individuals and families by reducing the amount they pay for monthly health insurance premiums. Cost-sharing reductions, on the other hand, help lower out-of-pocket costs like deductibles, copayments, and coinsurance. The amount of assistance you receive depends on factors such as your income and household size.16. What are the income limits to qualify for ACA health insurance subsidies or cost-sharing reductions?Income limits vary based on factors such as household size and location. Generally, individuals or families with incomes between 100% and 400% of the federal poverty level may qualify for subsidies, while those with incomes up to 250% of the federal poverty level may be eligible for cost-sharing reductions.17. Are there any tax implications or reporting requirements if my income changes after I enroll?Yes is the answer to this common question about ACA health insurance. If your income increases, you may need to repay a portion of your benefits when you file your tax return. On the other hand, if your income decreases, you may be eligible for a higher level of financial assistance. You should report this change promptly to ensure you receive the appropriate subsidies. Policyholder RightsLearn about your rights as an ACA policyholder in this section.18. How do I file an appeal if my ACA health insurance claim is denied?If your health insurance claim under ACA is denied, don't worry—Here's what you can do:Reach out to your insurance provider and ask for a detailed explanation of the denial.Gather any supporting documents or evidence that can strengthen your case.Follow the appeal process outlined by your insurance company, which typically involves submitting a written appeal with all the necessary information. 19. What are my rights as an ACA policyholder regarding grievances?If you're dissatisfied with the quality of care or services received, you have the right to file a complaint or grievance. This allows you to voice your concerns and seek resolution. You can typically find the specific process for filing a grievance outlined in your health insurance plan's documents. 20. Can I receive assistance in choosing the right ACA health insurance plan for my specific needs?We've saved the most common question about ACA health insurance for last—getting assistance in choosing the perfect ACA health insurance plan for your needs is not only your right but an also incredibly beneficial option.Our team of licensed insurance agents is eagerly waiting to lend a hand. Simply reach out to them at 1-800-314-5594 from 8 a.m. to 8 p.m. EST on weekdays. They'll offer personalized guidance, ensuring you make an informed decision and discover the ideal healthcare coverage tailored to your unique circumstances.Taking Control of Your Healthcare JourneyIn the winding journey of healthcare, it's empowering to realize that you're in the driver's seat. Navigating the Affordable Care Act might have seemed daunting, but these FAQs were designed to clarify the road signs and put your concerns at ease. You're not alone; you're backed by our team of licensed agents ready to assist you on your journey to optimum health coverage. Your health, your choices, your rights—this is the essence of ACA. 

How to Prepare For Your First Telemedicine Appointment

Imagine that you're traveling for work, and you feel a sudden sore throat coupled with sinus pain. Since you're on the road, you can't get to your primary care doctor, and you worry you'll miss tomorrow's big conference. So you do some research and determine that telemedicine is a good option for you to get a diagnosis and care for your symptoms. But what do you need for this first visit? This guide will explore the world of virtual healthcare and provide a detailed checklist to prepare for your first telemedicine visit. What is telemedicine? Telemedicine connects patients with medical professionals in real time by phone or online. Thanks to telemedicine, medical professionals can now evaluate, diagnose and treat patients using technology like video conferencing and smartphones - all without the need for an in-person visit. Still, telemedicine acts like an in-person doctor visit: Your online doctor provides the same level of health care that you would receive in an office. During your appointment, your doctor discusses your symptoms and develops a treatment plan. But it’s important to note that telemedicine is used for non-emergency health situations, like a cold, fever, skin condition, or sinus infection. Who uses telemedicine?People choose telemedicine for different reasons - mainly because it's a convenient way to get medical care without leaving your home.Maybe you're unable to travel to a doctor's office because of medical reasons or lack transportation. Or you might live in a rural area without medical services, so seeing a doctor requires traveling long distances. If so, telemedicine could be the answer, better fitting your schedule and saving you precious time.Since telemedicine visits happen in the privacy of your own home, you don't have to worry about travel time, long spells in the waiting room, or taking time off of work.What conditions does telemedicine cover?Telemedicine covers everyday illnesses such as the flu, conjunctivitis (pink eye), bladder infections, yeast infections, acid reflux, and certain skin conditions. Certain telehealth professionals can also provide treatment plans for mental health services, like the treatment of depression, anxiety or stress.What telemedicine doesn't include are emergency-related health concerns such as stroke, heart attacks, and major accidents.Your telemedicine checklistNow that you know a bit more about telemedicine, you may have questions on how to prepare for your first appointment. Follow this checklist to make the most of your appointment.#1. Choose a private placeFinding spur-of-the-moment privacy can sometimes be difficult, especially if you live with other people. So before your appointment, choose a quiet room for your virtual appointment and ask your family or roommates to respect your privacy. This way you won't worry about interruptions.#2. Consider technical aspectsWhether you're using a smartphone, computer or tablet, it's recommended to learn how to use the telemedicine company's app or video chat software beforehand. Some telemedicine companies may use well-known video services such as FaceTime (for Mac users), WhatsApp, and Skype (Windows). Or you might decide to simply speak to your doctor over the phone, if that's an option.Check with your telemedicine company ahead of time to learn the ins and outs. It'll help ease any stress or worry about the technicalities of the visit.#3. Prepare your medical historyWhen booking your appointment with an online doctor, you'll be asked to fill in your complete medical history and answer questions related to your symptoms. Be sure to gather relevant documents regarding your medical history ahead of time. For example, if your primary care physician offers an online health portal, it's recommended to have your information pulled up and ready to go for your visit.Your telemedicine doctor may also ask you questions about your lifestyle, job and family life and, if appropriate, your mental health history. The purpose of the appointment is to provide you with the best possible care and treatment. Sharing personal details allows your doctor to diagnose and provide quality care.#4. Get your documents readyLike any doctor's appointment, you should be ready with the following pieces of information:Your list of prescriptions, over-the-counter medications and supplements.Your pharmacy phone number and address.Your primary doctor's name and contact info.Insurance or credit card information.#5. Jot down questions to askIt's natural for a doctor's appointment to make you a little nervous - especially when it's with a new doctor. So you may forget to ask crucial questions during your visit.That's why it's recommended to make a list of questions to ask your online doctor. While each person's healthcare situation is unique, here are seven sample questions to get you started:What is the diagnosis?Will I need any medical tests?What can I do to get better?Do I need a prescription?What do I do if my symptoms continue?How can I access the information/treatment plan from today's appointment?Can I contact you if I have follow up questions?#6. Write down your treatment planYour treatment plan may be as simple as, "drink plenty of liquids and get some rest." But in some cases, you may need to have a prescription filled or to make an appointment to see another doctor or specialist in person. If possible, take notes on the treatment plan and what your next steps are during the appointment.#7. Discuss follow-up careIn some cases, one appointment is all you need to diagnose and treat routine health conditions like a cold or the flu. But if symptoms persist or you need ongoing care to check chronic conditions, you may need follow-up care through another telemedicine appointment or in person. You may also need a prescription, so discussing the next step is helpful.Fast facts about telemedicineToday, telemedicine is becoming more and more common. Here are some fast facts based on a white paper published by FAIR Health between 2014 and 2018:The number of telemedicine treatments increased by 1,393% between 2014 and 2018.After analyzing 29 billion private insurance claims, the study discovered that between 2016 to 2017, telehealth services especially rose by 53%.Urban areas experienced a 1,227% growth in telemedicine patients.The biggest group choosing telehealth were older millennials between the ages of 31-40.For decades, the U.S. Government has also supported telemedicine in rural areas to help rural populations access quality healthcare.Given this support and its rising popularity, telemedicine may become the new norm. The benefits are well-known, too:Convenient access: Patients can connect with healthcare providers easily in urban and rural areas.Lower treatment costs: Individuals, employers and insurance companies may benefit from lower prices when patients receive treatment and advice through telemedicine rather than using urgent care or emergency services.Specialist care: Telemedicine connects patients in rural areas with medical experts.Patient-centered care: Being able to talk with a doctor online at any time makes treatment focused on the patient and may improve positive health outcomes.How to get telemedicine careCheck with your health insurance company to see if telemedicine is an offered benefit. If it's not, you can get a "Teladoc" quote and purchase a plan through our site. The process is easy and takes minutes: The online application only requires your zip code, name and age. Once you enter this information, you'll receive your quote immediately.Teladoc is a large network of board-certified doctors and pediatricians who provide virtual healthcare anywhere at any time. Telehealth services offered through Teladoc depend on the health plan but can cover everything from everyday medical problems to mental health concerns.

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