Obamacare: will heart issue from years ago change plan cost?

I will be retiring soon and leaving my company provided insurance plan.  I’m six years away from qualifying for Medicare.  I had a stent placed in my heart in 2001. It was discovered before a heart attack.  Since then, I have gotten my cholesterol under control, gotten in shape, and had no other effects from the stent.  After several very positive stress tests, my cardiologist has told me my heart is very healthy.  As this occurred 12 years ago with no relapses, do I need to declare this when applying for a new insurance plan?  Can this condition be excluded from my coverage?  Will this change in 2014 with Obamacare?  In 2014, will I be charged a premium for this condition other than the standard charge for my age?  How will any of your answers change in 2014?

Soon to Hit The Colorado Slopes 

Dear Soon to Hit The Colorado Slopes, 

First, congratulations on a job well done for your heart health!  Here’s hoping for many healthy retirement years ahead.

Your question centers on the definition of “pre-existing condition”.  Not everything that a person has in his medical history counts as a pre-existing condition.  Yours is an excellent example.  A “pre-existing condition” for health insurance purposes is one that has been treated in the six months before the person joins a new plan.  If during the six months before joining the new plan, a person has been treated AND had a gap in his health coverage for 63 or more days, THEN and only then can the new plan refuse to pay for care related to the condition.

Since you have not had any treatment for the condition and you have had no gap in coverage, your retiree health plan will cover your bills for your heart care.  The new plan may ask you to show that you have had no gap in coverage; they can ask you for the “Letter of Creditable Coverage” from your old plan.

That is what happens after you are enrolled in a new plan.  We need to step back and talk about getting into a new plan.

When you are applying for an individual (non-group) plan, insurers are allowed to ask you medical questions and can surcharge your rate, or refuse to offer you a plan at all.  This is true for the rest of 2013.  As of January 1, 2014, insurers cannot ask you medical questions, adjust your rate, or refuse you.  It will be, as you say, based upon your age – not your heart history.  A group plan would not ask you medical questions, in any case.

You may find it cheaper (and easier) to keep your COBRA plan for the rest of 2013, and then review your options in 2014.  Colorado has a terrific Buyers Guide to Purchasing Health Insurance online, or you can use Healthcare.gov’s Plan Finder which has data about every state.

Best wishes for a terrific retirement.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.