Thursday, January 30, 2014


As a woman with congenital heart disease, and likely multiple open heart surgeries ahead, health insurance and all the rules and regulations that go with it is going to be an important part of my future.  This past surgery cost over $100,000 and the bills are not even all the way in yet.  Thank goodness my family's has health insurance or we would be paying that amount.  Needless to say, having good insurance that covers my CHD expenses as well as other issues that arise is very important for me.  Its not just me either, but the entire community of CHD patients that this worry falls to, although every case and situation is different. With the new Affordable Care Act (ACA) things have begun to shift and the coverage and rights granted to us CHDers have been expanded.  However, with all of the back and forth on the politics side of the law many of these new regulations have become misrepresented, clouded and confusing.  I found myself overwhelmed when learning about the new ACA and wishing I could better understand what this law meant for MY future. After doing a little research I have a better idea of how my health care rights, and the rights of others, have been expanded and would like to share them here.

I'd like to share that this post is not intended to analyze the entire effect of the new health insurance plan on the broader United States, but rather to lay out the benefits and changes which effect men, women and children with congenital heart disease.  Each person is different and the best insurance option for some CHD patients is not the same for others.  I will not attempt to analyze the different packages, but rather focus on the rights which have been expanded. The Affordable Care Act ushered in some important changes which have created different rights and rules that help those of us with this pre-existing condition.

So what has changed?

Pre Existing Conditions
The biggie for CHD is the change in policy for people with pre-existing conditions.  Before the act those with CHD could be denied coverage or have much higher premiums.  However, now this practice has been outlawed.  Now you cannot be denied coverage because of any disease as long as you are not under an insurance plan in which you were grandfathered in (a non job related plan bought before March 2010).  If you have a child with CHD (or another pre-existing condition) the insurance company (as long as not grandfathered) cannot drop them from the plan either.  Under the Affordable Care Act everyone has a right to insurance!

Now, if you are an adult with a  pre-existing condition previously without insurance and are now looking on the Government Insurance Marketplace, you can sign up for a short term health insurance plan as you review the market place options. For more information visit:

If you would like a more in depth look at how this system is projected to work check out this website: It is filled with a multitude of statistics, analysis and projections which can provide a window into this aspect of the ACA.

Up to age 26 you can stay on your parents plan

For those of us who are under the age of 26 and without health insurance of our own, we cannot be removed by the insurance company from the health insurance plan for any reason, no matter if we are a part of a grandfathered plan or not.  For more information:

Summaries of the plan

If you are like me, reading any type of insurance document is extremely difficult.  While it is possible to apprehend the full meaning of the document, it can be tricky and important information can be missed or misunderstood. The new health care law attempts to lessen those items we miss or don't understand by requiring a list of terms used in the insurance form to be provided.  It will also ensure a summary of the plan in plain language is given to the prospective buyer.

Lifetime limits

This is an important aspect of the law for those of us with CHD, especially those with multiple surgeries and more complicated cases.  Under the ACA no limits can be placed on essential treatments as long as the health insurance plan was purchased or renewed after September 2010.  Additionally, annual dollar limits can not be placed on the insured as well. You have a right to be treated for the essential problems. More info:

Preventative measures

This is an important section of the law for those of us with CHD.  There are often many complications which can arise with pregnancy, flu, pneumonia, illness, etc. and it is important that steps be taken to prevent these potential problems.  Although my poor little arm hates it, this means I, like many others, do not have to pay a copay or deductible for certain "preventative care" treatments.  As you can imagine, there are many different types of preventive care.  For a full list follow this link:

Now, this part of the health care law does have a few places where the right isn't always provided, depending on your insurance. Like the above mentioned rights, this measure only applies to those who have job related insurance or individual health plans purchased or renewed after September 2010. If you have a "grandfathered plan" (mentioned above) you may not be included in these benefits. There are a few catches with network providers and depending on how services are billed.  For more information on these restrictions see the following website:

and Finally, doctor choice and ER visits

Under the new law, you have the choice of your primary care doctor from a larger list of doctors in the area.  You can also be covered for Emergency Room visits to emergency rooms not on the list of hospital list for your area.  There are, like all of the above rights, cases were you will not be covered.  If you are grandfathered in or have not renewed your health insurance since September of 2010 you could run into trouble with this new rule.  For more information:

This is an overview of the new rights insured by the Affordable Care Act.  Many of these will come in handy with different potential problems which could arise and will help ensure you are not overly burdened with the financial aspect of having congenital heart disease. Isn't going through the surgeries and stress enough?   My overview does not go into the extreme depth of the law and so I have included links below to different resources on the services provided, the mechanics of the new law and the actual law itself!  Again, this blog post is not intended for a political argument, but rather to provide insight into the rights now available to all US citizens participating in the ACA.

Helpful resources:

  • (the law)


  1. Thank you for sharing this very informative article about the impact of the ACA on pre-existing conditions. I am glad to know things are getting better for people like you with CHD. Blessings!

  2. Thank you for helping in spreading the word about health care reform. There's a lot to be said about this issue, and some people do not actually know which part of the law could be of help to them. Getting the word out could help people get the help that they deserve and need. Cheers!

    Vince Rainey @ DECO Recovery Management