Medical Insurance & pre-existing conditions: How is it profitable?

[Flip_5]

"The Affordable Care Act (ACA) has required health insurers to cover pre-existing conditions without raising prices, limiting coverage, or turning you away." Just something I'm curious about: how is this profitable for insurers? Doesn't this mean that people who sign up for insurance are adversely selected towards having issues needing payment and therefore more likely to cause big losses for insurers? I'm Australian, but it's similar in Australia.

For example, if I have a pre-existing condition (medical implant/penile implant), I just sign up to insurance whenever I need a revision then my insurance might be down $50,000 USD after I made payments for a year. Shortly after the surgery, I close the account with them. I repeat this every time. I know there are waiting periods in many cases, but in the case of just mechanical malfunction, it's possible for someone to wait a year without much risk and do this. It may be similar with other medical issues. Also waiting periods vary, for some countries, it's 26 weeks for pre-existing conditions - but it can go up to four years (in Asia).

So, how does this work for insurers? Is it the case that the waiting period in combination with significantly jacking up prices of insurance means that it remains profitable for them to sell insurance? Even when people might go through this process of only signing up and paying when they'll need a large, highly expensive surgery and are willing to wait the one year or whatever waiting period?

By being forced to cover pre-existing conditions that means the insurers must make everyone else to pay to cover the costs of those who just sign up when they need costs covered.

In a world where covering pre-existing condition was not government mandate, would any insurance rationally decide to do so? What healthy person would sign up to an insurer knowing they were unfairly subsidising other people?

[Pumpkinman]

"The Affordable Care Act (ACA) has required health insurers to cover pre-existing conditions without raising prices, limiting coverage, or turning you away." Just something I'm curious about: how is this profitable for insurers? Doesn't this mean that people who sign up for insurance are adversely selected towards having issues needing payment and therefore more likely to cause big losses for insurers? I'm Australian, but it's similar in Australia.

For example, if I have a pre-existing condition (medical implant/penile implant), I just sign up to insurance whenever I need a revision then my insurance might be down $50,000 USD after I made payments for a year. Shortly after the surgery, I close the account with them. I repeat this every time. I know there are waiting periods in many cases, but in the case of just mechanical malfunction, it's possible for someone to wait a year without much risk and do this. It may be similar with other medical issues. Also waiting periods vary, for some countries, it's 26 weeks for pre-existing conditions - but it can go up to four years (in Asia).

So, how does this work for insurers? Is it the case that the waiting period in combination with significantly jacking up prices of insurance means that it remains profitable for them to sell insurance? Even when people might go through this process of only signing up and paying when they'll need a large, highly expensive surgery and are willing to wait the one year or whatever waiting period?

By being forced to cover pre-existing conditions that means the insurers must make everyone else to pay to cover the costs of those who just sign up when they need costs covered.

In a world where covering pre-existing condition was not government mandate, would any insurance rationally decide to do so? What healthy person would sign up to an insurer knowing they were unfairly subsidising other people?

Calling the ACA........ "Affordable" is comical enough.

[OhMyMy]

And when they don't pay even though you had jumped through all the required hoops... then what? They force you to go through arbitration via an arbitrator paid by the insurance company. Thank god THAT'S impartial!!!!

You did notice you had to sign that it's your responsibility, not your insurance company's, to pay the hospital and doctor, right???

[jsjwjw]

ACA health insurance is a great thing for some people and for others it is very very expensive.
A person with less than $15,000 income may have a zero premium on a Cadillac like plan.
A single person making $70,000 may have to pay $7-8 hundred dollars per month for a mediocre plan
Yes you can jump in and out of the plan but you can only do that once per year.
As retired insurance agent I can assure you that the insurance companies are making money in this program. If insurance company does not make money on a plan within a couple of years they will stop offering that plan.