Fact Check on Coverage for Pre-Existing Conditions

With increased attention on pre-existing conditions and the individual insurance market, we wanted to share the following information with you:

  • The vast majority of people under the age of 65 get their health care coverage through their employer.  People receiving coverage through their employer are guaranteed coverage regardless of pre-existing conditions, and the premiums they pay are not based on their health status.
  • The individual insurance market functions much differently. In an environment where some people choose not to purchase coverage, applicants undergo an underwriting process to keep coverage as affordable as possible for all policyholders. It provides a necessary incentive for people to purchase coverage before they need it, and to maintain coverage over time. According to the latest Census Bureau data, seven percent of people under the age of 65 get their coverage through the individual insurance market.
  • Coverage in the individual market is more affordable and accessible than is widely believed. In fact, according to AHIP’s latest individual market survey, 87 percent of people who applied for individual coverage were offered a policy.

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