What did/do people do when health insurance doesn't cover preexisting conditions?

[u/untakenusernameee]

If someone were to leave America and later move back, and by then health insurance companies can again refuse to cover pre-existing conditions, what would the solution even be?

Like in Australia, for example, there is a great, basically free public healthcare system, so although there can be benefits to private health insurance, you are also totally fine without it.

Whereas in America - before Obamacare, at a time when insurance companies could refuse to cover preexisting conditions, and should that happen again - if you let your insurance lapse or moved here from somewhere else then what would you do to get medical care for preexisting conditions, short of paying a billion dollars or just dying instead?

Edit: Wow, so many responses! Forgive me for responding here en masse. Thanks so much everyone for your thoughtful and detailed replies. I have such a better understanding than I did before. And I must say, many of these accounts are quite heartbreaking. I'm genuinely so sorry to each of you who have lived any of the terrible experiences described below. That kind of system and its effects should no question be illegal. As should much of what occurs in the health insurance industry! So thankful for Obamacare but there is still so much that needs to be improved - I hope that's the direction we go in. All the best to everyone. Take care of yourselves. xoxo

[u/ThellraAK]

The other thing I'm not seeing talked about enough here, is policy limits.

Have a premie baby? Better hope $X is enough to see them through their NICU stay.

There was also insurance for that. Think about it like having a second insurance policy, but the deductible is $1M or something crazy like that.

[u/warrmtape → u/ThellraAK]

YES! I work in health insurance and large employer groups over a certain size are exempt from a lot of the ACA rules, including Lifetime Maximums. I'm a communications professional and used to work for one of my prior insurance company's largest group accounts (post-ACA) and the employer was still implementing $1M lifetime maximums. I had to write a letter and send it out to a few people based on the customer's direction informing the member's coverage had been cut-off because they'd hit the $1M lifetime maximum. I forgot about this until just now. I've seen a lot of things in my 12 year career insurance, but the sinking stomach feeling I had back then when I had to do this came rushing back when I saw this post.

ACA eliminated lifetime maximum and coverage limits for most things / people, but not all.

[u/lellenn → u/warrmtape]

Oh shit I thought it got rid of lifetime maximums period. I didn’t realize some places are exempt. Can I ask what companies still have that limit so I can tell my 20 year old to never work there???? (She has heart defects so this is actually critical info for her).

[u/warrmtape → u/lellenn]

It isn’t the health care company itself, it’s large group employers / retiree plans who are self-funded who can impose these rules when they have over a certain threshold of employees/retirees enrolled in their plan. (The client I mentioned above was a group employer associated with the State of MI.) I don’t think this is common at all, so I wouldn’t worry! The example I mentioned was 10 years ago and the group could’ve made changes to their benefit package since then (I stopped working with them in 2017). I think it’s only allowed if the employer offers self-funded health insurance.

[u/lellenn → u/ThellraAK]

$1M wasn’t the deductible back then but it was the lifetime maximum an insurance company would pay for care. My daughter ran up 6 figure hospital bills after her birth because of having to be hospitalized and have her first surgery for heart defects. She’d have hit that limit in her first few years of life. Thank goodness she had Medicaid when she was born. And I’m so glad the ACA got rid of that lifetime dollar cap.

[u/ThellraAK → u/lellenn]

My father was an insurance agent, and sold reinsurance, where the primary insurance was on the hook for the first $1M and then it'd take over to the next policy limit.

Was a thing for New York Life at least.

His record for coverage was a $3M baby, and he was awfully smug about it because management of the company had to be convinced it was worth it to pay for an insurance that'll "never be used"

[u/lellenn → u/ThellraAK]

Ah so you mean a $1m deductible for like the insurance company then?

And now of course I know my 20 year old will always be uninsurable for life insurance except through work because of her heart defects. Apparently insurance companies use some weird outdated actuarial tables that have them convinced she will drop dead tomorrow or something. I’m glad that for right now she has good health care but I am so scared for the future for her.

[u/ThellraAK → u/lellenn]

It's still for the beneficiary.

Think about it like switching insurances when you hit the cap on the first one.