Saturday, 9 March 2019

Health Insurance for Heart Disease Patients

If you buy health insurance through your state's Marketplace, on the individual market, or through an employer with 50 or fewer employees, your plan must cover certain Essential Health Benefits.  With a chronic heart problem, you will have many protections under the Affordable Care Act: You cannot be dropped by your health plan because you have a heart problem or a condition that can lead to heart disease, such as high blood pressure or high cholesterol.


You may need some of these services as a heart patient, such as:
  • Counseling for diet, smoking cessation, alcohol abuse, or depression to learn how to lower your chance of complications from heart disease

  • Prescription drug coverage
  • Your out-of-pocket costs will be limited. Health plans will have what is called an out-of-pocket maximum. Once you reach that amount through your deductibles and other cost-sharing, your insurance company covers the rest of your costs. That includes what you would spend on copays and deductibles for medical services and prescriptions. The out-of-pocket maximum does not include your monthly premiums.
  • Emergency room and hospital coverage
  • Rehabilitation services

If you get insurance through your job, check your health plan to confirm the details of your coverage. Large employers are not required to offer the Essential Health Benefits, but nearly all do.

Reduced Costs to Treat Heart Disease

The Affordable Care Act has rules about the most you have to pay out-of-pocket for your medical care.

Individual health plans may add to those minimum requirements. So before you enroll, read the plan's summary of benefits to see what specific services you’ll have access to and what your costs will be
  • Health plans cannot impose annual or lifetime dollar limits on your benefits.
  • You might be able to get financial help to pay for some costs if you're buying insurance through your state's Marketplace. You may be able to get a tax credit to lower your insurance premiums. You can find your state’s Marketplace by going to
  • You might qualify for Medicaid coverage, even if you haven't in the past. This will depend on how much you earn and the state you live in. See Medicaid Expansion: At-a-Glance to learn more. You can find out whether you qualify for Medicaid by going to your state’s Marketplace


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