Guaranteed Issue Health Plans and Health Reform

This site is mainly about getting the most health subsidy that you are eligible for and we're serious in that aim. After all, it could mean 1000's to 10's of thousands of dollars per year to you and your family.  Those are serious numbers and we felt it warranted an in-depth discussion on how to maximize it.  There's another important change resulting from the Health Reform law that we need to discuss...Guaranteed Issue health plans.

A quick definition of Guaranteed Issue health insurance

This is a major change in the health insurance market for individual and family health insurance.  A major issue in purchasing health insurance on the individual market (and depending on the State, the group health market) has been health qualification.  In most markets, an insurance carrier could decline coverage or increase the premium charged based on the health status and history of the application.   Depending on your State and the carrier, roughly 50-80% of the applications might be declined or rated up.  This has been a big problem in the health insurance market despite various high risk pools and the temporary PCIP plan as part of the Health Reform bill.  It often left people with no or very bad options.  That's going away Jan 1st, 2014.

Effective Jan 1st, 2014, health history and status will not impact qualification

It's hard to say whether Guaranteed Issue on the individual/family market or the Health Subsidy is the biggest change coming our way but they're both up there.  Here's the landscape for the Guaranteed Issue changes. 

An eligible person cannot be declined coverage due to health status or history.  Essentially, the whole issue of pre-existing conditions go away.  Health history goes a little deeper and speaks to past health issues which previously would affect a person's ability to qualify such as certain types and stages of cancer in one's history.  An insurer can also not increase a person's insurance premium based on their health status/history or apply waiting periods or waivers to pre-existing conditions.   A person's premiums can also not be increases later on if health changes.  Keep in mind that rates can increase by other criteria such as age bands, area, and based on claims experience for large groups (such as by State).  Rates just can't be increased based on your individual claims experience for you alone. 

Windows for Guaranteed Issue Enrollment

Depending on each State's interpretation of the rules, there will likely be open enrollment windows (such as October 1st through Dec 31st) and certain qualifying events during the year (such as losing group health insurance or moving States).  If you do not enroll during these windows, you will likely have to wait till the next window.  This restriction plus a penalty for not purchasing health insurance will be the "stick" to motivate people to enroll while the health subsidy will be the "carrot".   Guaranteed Issue is applicable to both plans in and out of the Exchange.


Los Angeles, Family of 4
making $60K.

Iowa, Single Adult making $30K

*Based on age, expected costs, and other assumptions according to Kaiser Calculator.  Actual subsidies will vary and official subsidy amounts will be available Oct 1st, 2013. 

Health Subsidy Calculator



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