Tuesday, February 9, 2016

In need of annual checkup for pre-existing condition, but no insurance will cover me. What now?


Question: I am writing on behalf of my brother who was born with a congenital heart disease.  He has congenital aortic stenosis.  When he was 15 he had a balloon angioplasty too and has to go back annually for a checkup.  He has recently lost his insurance, so can not go back for his annual checkup this year, as no insurer will pick him up, because of his pre-existing condition.  Is there anything that can be done, so that he can still get his annual checkup? Thanks for reading this question.  

- Brian

Brian - Your brother should be able to get his check-up after January 1. Starting on October 1, he will be able to purchase coverage through an insurance exchange, and it will become effective beginning in January. Insurance companies will not be allowed to turn him down or to charge him more because he has a preexisting condition. In fact, they will not even be allowed to ask whether he has one. If his income falls below 400% of the federal poverty level, which is $45,960 in 2013, he will also qualify for a subsidy to help cover the cost.


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  • Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog. Ask Rob your questions about the new healthcare laws.

    Professor, Drexel University Kline School of Law & Dornsife School of Public Health
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