What to expect when seeking ACA market place insurance if I have AML?

Posted by pefishback @pefishback, Feb 19 2:20pm

I was diagnosed with favorable-real AML in February, 2025 and have been in remission for five months. Currently no immediate plans for a BMT.

I retired early and will need to seek insurance on the market place for a couple years prior to turning 65. My understanding is that under ACA,

1. A carrier cannot deny me coverage based upon my pre-existing condition.
2. A carrier cannot charge me a higher premium based upon my pre-existing condition.
3. The carrier cannot impose a lifetime maximum coverage amount for my leukemia care.

Please let me know if my understanding is incorrect.

So, how should I expect my leukemia to affect my coverage? For example, should I anticipate a higher annual deductible? A higher percentage of cost-sharing? Reduced prescription coverage?

I’ll be enrolling next fall and am already working with a broker. But I’d like to hear from others about challenges they’ve faced. Recommendations in favor of or against particular carriers, e.g. BCBS, Priority, etc. are welcome, either by posting a reply or by sending me a private message.

Interested in more discussions like this? Go to the Blood Cancers & Disorders Support Group.

mikxtr | @mikxtr | Mar 2 7:55pm

I am in the health insurance profession, particularly the CA ACA market and am happy to answer your questions, although I cannot make a recommendation.

All of your assumptions are correct: an issuer cannot turn you away or charge you extra for prior conditions. The only factors that should impact your rate are age, where you live, which plan you select and whether you smoke (in some states). I do not believe any other factors can be applied, although different states may have different restrictions.

If your income is low, you may qualify for a premium subsidy (< 400% fpl) and perhaps even a cost sharing subsidy (< 250% fpl). fpl means federal poverty level.

Make sure you check with your broker to look at exchange plans: you can only get subsidies through the state exchanges.

Otherwise, everyone is subject to the same rules, no exceptions.

Hope this helped. Good luck.

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