Navigator Guide FAQ of the Week: Can Insurers Ask About Your Health History?

With just one month left in the open enrollment period for most of the Affordable Care Act’s marketplaces, CHIR is here to help answer your questions. We’ve updated our Navigator Resource Guide to reflect all of the federal health policy changes that have occurred over the last year and have provided answers to hundreds of frequently asked questions (FAQs) ranging from data matching issues to the emergence of new coverage options and how to determine if your doctor is in a plan’s network.

Recently, consumers have been inundated by health care-related robocalls from scammers attempting to sell them phony policies or glean their personal financial information over the phone. Consumers should beware of anyone trying to sell insurance over the phone and should not disclose their personal or health information to an untrusted source. Therefore, as our second FAQ of the Week, we’re highlighting when an insurer or navigator might ask about a consumer’s health history and when such questions would be inappropriate:

QUESTION:

Is an insurer allowed to ask me about my health history?

ANSWER:

In general, if a plan offers the ACA’s protections, an insurer should not require you to answer questions about your health history when you are applying for a plan. A navigator or broker may ask about your health history to guide you to the most appropriate plan offerings, and no plan offered on the ACA marketplace through HealthCare.gov will require you to answer such questions.

If you are purchasing a plan outside of the marketplace and an application requires you to answer questions about specific health conditions, or asks you to check a box to release your medical records, you may be applying for a plan that will charge you more or limit your coverage based on preexisting health conditions. These plans do not provide the ACA’s protections guaranteeing coverage to people with preexisting conditions and setting limits on out-of-pocket costs. Ask a reputable broker (you can fund one by contacting your Department of Insurance) to look at the plan details and proceed with caution, especially if purchasing a plan online or over the phone.

For answers to this and hundreds of questions on marketplace eligibility, financial help, coverage options, and more, visit the Navigator Resource Guide here.

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