The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of our blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service.  Today, we will discuss the second “unintended consequence” of health reform, which addresses how new individual insurance policies are prohibited from applying pre-existing conditions exclusions for children under 19.

No Pre-existing Conditions Exclusions for Children Under 19

While PPACA’s intent was to make all children under 19 insurable in the individual marketplace regardless of their existing health conditions, the “unintended consequence” is that most insurance companies around the country stopped insuring children under 19 through individual policies.  As I discussed in a previous blog article, when you combine a mandatory open enrollment period that could last all year with a ban on excluding pre-existing conditions, you have a recipe for a disaster.  Why would parents purchase insurance for their children when they were healthy and pay for those insurance premiums when parents could just wait until a child was sick or injured and purchase insurance at that time?  Obviously insurance companies are in the business of insuring against “unforeseen risk”, and this government mandate removed “unforeseen” right out of the picture.

What does this mean to you?

Prior to September 23, 2010 healthy children were able to secure insurance coverage in the individual market.  Unfortunately, most insurance companies aren’t insuring children today regardless of how healthy they are.