Insurance Question with Consideration of DSM-5

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I had an odd question. I was diagnosed in April with Aspergers + Adjustment Disorder (with mixed anxiety and depression).

I just found out that my Insurance Carrier (Aetna) decided to stop selling individual health insurance plans in California at the end of 2013. This means I have to shop for new insurance soon.

Question: Will I need to cite Aspergers as a pre-existing condition, now that it is no longer a formal diagnosis?

As a note, I am a bit perturbed about the situation. I figured having Aspergers wouldn’t be an issue (vis a vis pre-existing condition) as I figured I would simply continue carrying Aetna insurance until I was 65 (I am 50 now). I never figured that Aetna would exit the insurance market. Go figure.

I have good news for you. Not only is California finalizing a best of breed insurance exchange right now (to start January 2014), but effective Jan 2014, "pre-existing conditions" are no longer a factor in getting insurance.

This is possibly why they made this announcement - they know everything changes at the end of the year. In fact, the target is to have all plans finalized in October (but don't hold your breath on that one).

It isn't a perfect plan, but there are some excellent consumer protections built in.

due to the affordable care act, starting in 2014, pre-existing conditions will not be an issue.

Regarding "pre-existing conditions"...does everyone in the "pool" pay the same monthly premium without regards to pre-existing conditions?

Yes, but - age and adverse voluntary habits (smoking, drug abuse) are allowed to be rated (priced up).

The exchange isn't a pool, exactly. It is companies that have submitted proposals to the state to be included as an option. If you are familiar with Medicare Supplement plans - it is kinda like that, but includes the full Medicare option as well. Self pay from a menu based on your needs.

The things that the ACA prohibits now include:

* No pre-existing condition clauses or waiting periods
* No kicking kids off - they can be covered under their parent's plan until age 26
* No maximums (think kid with leukemia kicked off at age 8 because of cost)

When the exchange is finalized, the competitive "winners" (noting this is still basically a for-profit system, unlike the more efficient Medicare) will have their wares on display - we offer this, that and the other - and it costs $x.

What I am not sure of is the cost. Last I heard, it was restricted to charging someone ~50 no more than 3x what they charge someone who is ~20, so it is indexed to age (and some voluntary risk factors like a smoking habit). Those specifics may have changed.

A good resource on the rollout of the ACA is http://www.pnhp.org (pro national healthcare physicians group tracking this rollout), and for CA http://www.coveredca.com (the CA exchange resource page). You can give the latter a call and they can fill you in on what is going on in your state specifically. They also have a calculator for cost - but note that may be a default very high deductible plan...

Rocket, although I don't know the specifics I do know that if you try to acquire new insurance immediately, you will be given a form of favoritism since you have had coverage within the past 60 days.

Don't go on the exchanges if you want to keep your job, unless you are self employed. Employers will be fined for each employee that goes on an exchange. Try to get a high deductible or hospital-only plan and apply for as many of those as you can.

I went to Coveredca.com and took the assessment. Insurance for me would cost $317/month. Way too expensive. Seems like I'd be better off being homeless under a bridge and get Medicaid.

Thanks everyone for the information.

Currently, both my wife and I are self-employed. As such, we are planning to get a new policy beginning in 2014 (as our current insurance expires on 12/31/2013). I imagine we simply need to wait until later in the year (~ October 2013) when things are “clearer”.

I don't know if October is going to be realistic. Right now, only CA and VT have released their state exchanges, and the Federal exchange isn't even a gleam in it's Daddy's eye right now by most accounts.

Definitely keep an eye on this though. I have a feeling that anyone not on an employer plan will be on pins & needles towards the end of the year - meaning media coverage should pick up significantly (or one would hope).

Rocket, this is an issue for me as well although I don't want my employer to pay the 'Obamacare penalty'. A lot of places offer very high deductible catastrophic and hospital-only plans, could these be an option? My situation is different from yours as my diagnosis is very old. But this could be a solution... Just try?