Pre-existing condition clause with new employer

Jenny B. on May 7, 2014

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I an an oncology social worker.  I am working with a breast cancer patient who just lost her job.  She has health insurance thru her employer.  She still has a couple surgeries and then she has an opportunity to get a job at a place she used to work,  likely around September.  They offer group health insurance.  Does the ACA protect her from a pre-existing condition clause or does that only apply to individual plans thru healthcare.gov.


2 Comments

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Monica Bryant

May 7, 2014

Cancer Rights Attorney Comment:

Hi Jenny, 

Thank you for your question.  The Affordable Care Act (ACA) prohibits health insurance companies from discriminating against people based on a pre-existing condition.  That applies to all health insurance policies, not just those being sold in the Health Insurance Marketplaces.  Additionally, people cannot be charged more because of their pre-existing condition.  For more about the ACA and pre-existing conditions, visit https://www.healthcare.gov/how-does-the-health-care-law-protect-me/#part=3

You patient has a couple of options to maintain her health insurance during the period she is not working.  Her first option, assuming she worked for a private employer with 20 or more employees or a state or federal government, would be to elect COBRA.  If eligible, COBRA would give your patient the right to maintain the exact same health insurance she had through her employer for a period of 18 months.  The downside to electing COBRA is that it can be very expensive, because she would be responsible for paying up to 102% of the premium.  For more information about COBRA, visit http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html. 

The other option that your patient has is to shop for new insurance through her state's Health Insurance Marketplace.  Although open enrollment for 2014 is closed, losing one's job would trigger a special enrollment period of 60 days.  Depending on her family size and income level, your patient may also be eligible for financial assistance to purchase a health insurance policy in the Marketplace.  For more information about the Marketplaces, visit: http://healthcare.gov.  

I hope that answers your questions. 

Best, 

Monica Bryant, Esq.
Cancer Rights Attorney
COO, Triage Cancer

Please note that the above information is designed to provide general information on the topics 
presented. It is provided with the understanding that the expert is not engaged in rendering any legal or professional services in the information provided above. The information provided should not be used as a substitute for professional services.

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Jenny B.

May 7, 2014

Great news!   Very thorough response- so appreciate the suggestions for alternate options to COBRA.   Thank you!

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