Looking to enroll in a new individual or family health insurance plan? Don’t submit an application for health insurance until you read this!
The passage of the Affordable Care Act, or Obamacare, in 2010 brought about a lot of change in regard to how a good portion of the American public shops for health insurance.
The most obvious example of the changes that have taken place can be found in the health insurance marketplaces (also called exchanges) that were set up in the ACA’s wake. People without adequate health coverage through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or some other source can use these federal or state-run websites to find and buy coverage.
Another example, though, becomes visible when a person goes to fill out an application for one of these individual (or family) health insurance plans.
Before Obamacare, companies offering this kind of insurance would ask people to include all sorts of information on their applications. For example an application might include the date they’d like their coverage to be effective and whether they or anyone else named on the application previously had been denied insurance or had an insurance policy canceled or rescinded.
Companies also asked applicants to share a bunch of health details about themselves and any other family members looking to be covered. Insurers often used this information to determine a person’s premium rates. They also sometimes used this information, especially if it was incorrect, to terminate an approved insurance contract.
For the most part, the days of the above are over thanks to the Affordable Care Act. Applicants no longer have to identify when they want their coverage to go into effect. This is because most of them only can apply during certain, strictly defined “open enrollment” periods. These begin near the end of the year and the effective date of coverage for those folks usually falls on the first day of the following year.
(Some people will be able to apply for coverage outside of this window, during a “special enrollment period.” But they’ll have to have been kept from taking advantage of the open enrollment period by one or more of a handful of “life events” that are detailed in our article, “Understanding the Affordable Care Act.”)
Today, those applying for individual or family health insurance plans through the federal or state-run marketplaces no longer need to worry about providing the entire, intricate medical and health histories of themselves and their loved ones on their applications.
That’s because one of the main reforms attached to the ACA prohibited insurance providers from refusing to sell or renew plans because of a person’s pre-existing conditions or from charging higher rates because of a person’s health status.
As a result, one of the only health-related questions you’re likely to find on an application is: have you used any tobacco products regularly (four or more times per week) within the last six months?
This question will show up from time to time. Just not on applications related to the federal health marketplace or even a few of the state-based ones. This is because the Affordable Care Act allows insurance companies to charge people who use tobacco products up to 50 percent more for premiums. It also allows states to mandate a lower percentage or no surcharge at all. A number of states have taken the government up on this offer.
The only other health-related questions you may encounter while filling out an application via one of the state-run health insurance marketplaces--you won’t see them mentioned on applications tied to the federal exchange—are likely to be optional.
For example, LifeWise Health Plan of Washington’s application includes a small section that asks people the following questions:
These questions aren’t included so the provider can deny coverage or increase the premiums of those who apply for health insurance; they’re asked so the provider can assist people who may answer "yes" to one or more of them.
Applications tied to the federal and state exchanges focus on information that should be readily available or easily accessible, including the names, genders, dates of birth, and Social Security Numbers of anyone who may be named in the policy.
Health insurance applications also may ask you to share the following:
The point of these questions is to let you know if you qualify for any subsidies, credits, and the like. But some insurance companies will ask you to share this information for statistical purposes.
If you attempt to apply for health insurance after open enrollment has closed, you’ll also be asked to specify if one or more of a long list of “qualifying events” prevented you from picking a plan during that period.
Among the events that could qualify you to buy a plan as part of a special enrollment period are:
Earlier, it was mentioned that the Affordable Care Act allows insurance companies to charge people who use tobacco products up to 50 percent more for premiums than people who don’t use them.
Aside from that, companies are only able to take into account the following four pieces of information—all of which are likely to be included on an application you fill out--when determining how much you’ll pay for health insurance:
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