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Under Obamacare, why can't insurance companies deny coverage by raising the price?
If now under Obamacare, you cannot be denied coverage for a preexisting condition, what keeps the insurance company from just sending you bill for $5M for the year? This is not saying they won't take you as a customer. It just forces you to decline due to high cost.
So, there has to be a predefined premium for any 35 year old (just picking an age) non-smoker? Everyone that meets these criteria have the same premium.
Hypothetical: I'm a 35 year old non-smoker that has skin cancer. I have the same premium as 35 year old non-smokers without skin cancer. I just need to cover the deductible.
6 Answers
- Anonymous7 years agoFavorite Answer
Actually this is a very good question. The answer though is quite simple.
Insurance companies can no longer use your medical history as part of the underwriting process (other than for things like smoker/non-smoker status). And Alice is correct that the healthy insureds "...are the ones who foot the bill for the sick ones." If you like the idea of government picking winners and losers, you're probably in favor of this plan. If not, you're probably against it.
Source(s): Independent insurance agent, ACA certified and authorized - AnonymousLv 77 years ago
Clearly if the insurance company was offering policies for $5 million dollars per year, then they would lose all of their customers. Also, even before that happened, the insurance company would send their proposed rates to the insurance commissioner and they would, of course, be denied from offering a ludicrous rate.
Rates are fixed and approved by the insurance commissioner. Insurance companies are really guessing on what they need to charge at this point, because they have no idea. But, yes all 35 year olds on the same plan in the same area will pay the same rate. Smokers can be charged a higher rate, but cancer or no cancer is the same.
Lastly, if an insurance company feels they can't be competitive in a certain state, then they just stop selling there. Aetna sold in my state until late last year. They just didn't see it as worth their time and effort, packed their bags and left.
- StephenWeinsteinLv 77 years ago
If you are a 35 year old non-smoker that has skin cancer and you buy insurance through the exchange, then you have the same premium as 35 year old non-smokers without skin cancer who live in the area where you do and get the same insurance.
If you are a 35 year old non-smoker that has skin cancer and you get insurance through work, then you have the same premium as 35 year old non-smokers without skin cancer who work at the company where you do and get the same insurance.
There is not just one premium for every 35 year old non-smoker. There are different premiums in different places. There are different premiums for different insurance plans. But all of the premiums are the same for someone with cancer and someone without cancer.
They don't have to charge everyone the same price. But they can't charge you more because of cancer. They can charge more because of where you live or work or what insurance you pick.
- AnonymousLv 77 years ago
Because DENYING COVERAGE and RAISING PRICE are two different things. That's like saying, why can't a dog be a cat. Silly.
When you buy insurance, the terms are disclosed UP FRONT. BEFORE you buy it. The deductible, the premiums, the coinsurance, EVERYTHING. It's YOUR CHOICE if you buy it or not.
But insurance is the most heavily regulated industry out there - even more so than those oil drillers. There's heavy government oversight at the state level. The insurance companies WILL follow the contract.
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- AliceLv 77 years ago
No, it does not work that way.
You get your coverage for the policy price. There is no charging $5 million for expensive conditions. The healthy subscribers are the ones who foot the bill for the sick ones.
- ?Lv 77 years ago
Because those with pre-existing conditions also cannot be charged more in premiums because of it.