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What Does Guaranteed Issue Health Insurance Mean?

by | Oct 13, 2024 | Health Insurance

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You Can Not Be Turned Down For Health Insurance

Guaranteed issue means that the health insurance coverage is guaranteed to be issued to applicants, regardless of their medical history, their age, their gender, or any other factors that might increase their likelihood of using health services. In most states, guaranteed issue doesn’t limit what you can be charged when you enroll in a plan.

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What Does Guaranteed Issue Health Insurance Mean?

The Affordable Care Act and Guaranteed Issue Health Insurance

Prior to 2014, individual market health insurance companies determined an applicant’s eligibility largely based on their medical history. Applicants could be denied coverage, either altogether or for certain conditions, if the health insurance company decided that they were more likely to use their coverage than the average member.

In other words, the individual market health insurance was not guaranteed issue. Many pre-existing conditions were an automatic decline, and that person could not ever get coverage through that insurance company. The only exception was through an employer, either a small or large group of employees. If the employer offered the coverage, the employee and family could get covered.​

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This changed in 2014 when most of the Affordable Care Act’s provisions took effect. The ACA required that all individual market major medical plans be guaranteed issue, meaning that they could not turn applicants away based on any factors including pre-existing medical conditions. You were no longer pushed into a corner to try and find an employer that offered group coverage.

To ensure individuals and families that did not have employer provided health care wouldn’t simply wait until they needed coverage to purchase coverage, the enrollment period was limited to a single “open enrollment period”. To make provision for those who had a “life change” (marriage, birth of baby, move, etc.) that affected their insurance needs, there were special enrollment periods instituted.​

 

Nevada Insurance Enrollment Is Here to Help

Health insurance is a necessity; for most people, the medical bills that result from a single injury or illness could wipe out their savings and seriously jeopardize their financial future. At Nevada Insurance Enrollment, our health insurance agents are here to help you get the coverage you need, regardless of your medical history.

Medical Loss Ratio

Medical Loss Ratio

This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.

Why You Should Always Use an Insurance Agent

Why You Should Always Use an Insurance Agent

Insurance agents are licensed professionals who specialize in connecting people with the insurance policies that are right for them. They help the customers understand their coverage by studying all the insurance company’s policies and procedures.

 

By page visits (this month)

#1) Health Insurance Subsidy Chart

#2) Health Insurance

#3) Health Insurance WITH a Subsidy

#4) Insurance Blog

#5) Request a Quote

By page visits (this month)

 

#1) Health Insurance Subsidy Chart

#2) Health Insurance

#3) Health Insurance WITH a Subsidy

#4) Insurance Blog Posts

#5) Request a Quote

Filing An Appeal To A Health Insurance Company

If your health insurance company refuses to cover a claim, you have the right to appeal the decision and have it reviewed by a third party. Your policy should outline how to appeal a denial.

Health Insurance Deductible

A deductible is an amount you pay before the Insurance Company starts paying. Health insurance plans will have different deductibles. You’ll be expected to pay the whole medical bill out of your own pocket until you’ve paid your deductible.

Comparing Medicare Advantage To Medicare Supplement

During the Medicare Annual Election Period (AEP), which is from October 15th through December 7th each year, many people may ask the question, “Do I want a Medicare Advantage Plan or a Medicare Supplement Plan (Medigap)?”

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