Could A Continuous Coverage Requirement Offer The Same Results As The ACA’s Individual Mandate?

Source: linkedin.com | Re-Post KSS Insurance 2/7/2017 – 

A closer look at a key provision proposed by the GOP

The debate to repeal and replace the ACA (Obamacare) continues. As an alternative to the individual mandate, several GOP proposals keep the ACA’s protections for people with pre-existing conditions, but only for policyholders who maintain “continuous coverage”. Many people aren’t really sure what this means. About 48% of Americans are covered by an employer-based health plan. If you are one of them, you probably have never had to worry about guarantee issue or pre-existing conditions. Here’s what this means and why you should care.

Simply put, there would be no mandate to have insurance coverage. But , if you allow your health insurance coverage to lapse for more than 63 days, you will not be guaranteed approval when you apply for coverage again.

There are at least six leading GOP proposals to replace the ACA. If Sen. Price’s model (Empowering Patients First Act) moves forward as proposed, this is how it might work:

1.) When you apply for health insurance coverage the insurance company will require proof that you have been covered without a lapse in coverage of more than 63 days. If you have not had a lapse in coverage, you can be guaranteed approval, no matter your current health status or pre-existing conditions.

2.) If you have lapsed, insurance companies are allowed to charge higher premiums or decline an application for coverage. If approved, the policy might not cover a pre-existing condition for up to 18 months.

3.) If you cannot qualify for a private plan, you can apply for coverage in a state-run High-Risk Pool. (which charges more and covers less than a typical policy)

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