What if I Have a Preexisting Condition?
A preexisting condition won’t keep you from getting any health coverage. Starting January 1, 2014, no insurance company may exclude you from coverage because you have a chronic or disabling illness or injury because you’ve received recent treatment for a medical condition. This also means an insurance company can’t charge you extra if you have a preexisting condition. This applies both to plans sold in the Health Insurance Marketplace and group health insurance plans provided by employers.
With that said, if you currently have an individual plan that excludes preexisting conditions, that plan is “grandfathered” and doesn’t have to change its rules. However, you are free to switch to a Health Insurance Marketplace Plan starting October 1, 2013. Your preexisting condition will be covered when the new plan takes effect on January 1, 2014.
What if I Am Pregnant and Want to Buy a Marketplace Plan?
An insurance company may not deny you any coverage because you are pregnant when you join a health insurance plan. However, insurance companies can still impose waiting periods for certain benefits. Fortunately, the healthcare reform law now has a limit on these waiting periods. A waiting period for maternity care benefits can be no longer than 90 days. So if you are pregnant when you join a healthcare plan, the longest you have to wait before your insurance company has to pay for your maternity care, labor and delivery costs is 90 days, or about three months.
What if I Work Part-Time and Want to Buy a Health Insurance Marketplace Plan?
If you are employed but you work part-time, you may purchase a plan through the Health Insurance Marketplace. If you aren’t eligible for your employer’s group health plan, depending on your income level, you may be eligible for lower policy premiums, thanks to the “advanced premium tax credit.” There are also cost-sharing subsidies that can make you eligible for lower out of the pocket costs, depending on your income level.
If you are eligible for your employer’s group health plan even though you work part-time, you aren’t eligible for these cost savings, unless the coverage your employer is offering is not considered affordable. If you have to contribute more than 9.5 percent of your income toward your employer’s plan, it’s not considered affordable.
What If I Run a Small Business With Employees?
If you run a small business and have employees, you will soon be able to use the SHOP Health Insurance Marketplace for employers. SHOP stands for Small Business Health Options Program. The SHOP Marketplace will include plans with the same essential health coverage as the individual Health Insurance Marketplace.
You may be able to qualify for a tax credit of up to 50% of the premium costs you pay for your employees if you obtain insurance through the SHOP marketplace. Your business is eligible it is has fewer than 25 full-time employees (or 25 full-time equivalents) who make an average of $50,000 or less. If you have fewer than 10 employees who are paid an average of no more than $25,000, you are eligible for the highest tax credit.
Read more about the small business health care tax credit on the IRS website. You can learn about requirements for larger employers in Nolo’s article about the employer mandate in health care reform.