Can you be denied health insurance in America?

 

Millions of Americans depend on health insurance to afford the necessary medical care. But not everyone qualifies for health insurance, and some people might not be accepted. Having your health insurance application rejected can be upsetting and stressful, leaving you with few options for getting the care you need. The reasons why someone might be denied health insurance in America, the legal safeguards in place to stop such rejections, and the possible repercussions of being rejected coverage are all covered in this article.

Why Do Americans Lack Access to Health Insurance?

An insurance provider may refuse to provide health insurance for a number of reasons. The following are the primary causes:

1. Pre-existing Conditions: Prior to the Affordable Care Act (ACA) being passed in 2010, individuals with pre-existing conditions including cancer, diabetes, or heart disease might be denied coverage by insurance companies. Because of the ACA, insurance providers are no longer allowed to refuse coverage due to pre-existing diseases. Pre-existing conditions may still not be covered by all short-term health policies.

2. Age: Some insurance providers may charge older folks greater prices or refuse to cover anyone above a particular age completely.

3. Income: Those with low earnings might not be able to buy health insurance and might end up without coverage because they cannot afford the premiums.

4. Employment Situation: Compared to full-time employees of an employer that provides health benefits, those who are self-employed or work part-time may find it more difficult to secure health insurance coverage.

5. Lifestyle Habits: People who smoke, have a high Body Mass Index (BMI), or indulge in other dangerous behaviours may face increased premiums or coverage denial from some insurance carriers.

6. Residence Status: Undocumented immigrants may find it difficult to secure private insurance coverage and are generally ineligible for most public health insurance programmes.

Legal Defences Against Refusals from Health Insurance

Several laws and rules have been implemented at the federal and state levels to safeguard consumers from unfair denials of health insurance coverage.

1. The Affordable Care Act (ACA): The ACA forbids insurance companies from refusing coverage to persons with pre-existing diseases and stipulates a list of essential health benefits that must be covered by all health plans. Health Insurance Marketplaces were also created, allowing customers to compare and buy different health insurance options.

2. The Consolidated Omnibus Budget Reconciliation Act (COBRA): Under COBRA, businesses are obligated to continue providing their employees with health insurance coverage in the event that they leave their jobs or have their hours reduced. This coverage has a maximum 18-month duration.

3. The Health Insurance Portability and Accountability Act (HIPAA): HIPAA safeguards individuals with pre-existing diseases by enabling them to change from one group health insurance plan to another without having their coverage rejected.

4. State Insurance rules: To safeguard consumers from health insurance denials, many states have their own rules and regulations. For instance, some jurisdictions forbid insurance firms from raising prices based on an individual's age, while others mandate that all people have coverage, regardless of their condition.

Consequences of a Health Insurance Denial

For individuals and families, being denied health insurance can have major repercussions. Without insurance, people might not be able to afford the necessary medical care, which would ultimately result in worse health and increased healthcare costs. The following are some possible repercussions of receiving a health insurance denial:

1. Postponed or Ignored Medical treatment: People without health insurance may put off or neglect receiving essential medical treatment, such as screenings, exams, or prescriptions. Future, more severe health issues may result from this.

2. Higher Out-of-Pocket Costs: People without insurance can be forced to cover their own medical costs, which can be unreasonably expensive. Some people may still have high deductibles, copays, or coinsurance even with insurance, which can make medical expenses more expensive.