The short answer: private plans ask health questions because the carrier decides who it approves. Answer every question fully and accurately, and have your doctors and medications written down before you start. Have a health condition? Tell us first: depending on the condition, a private plan may still be an option.
Why a private plan asks
Private plans are not part of the Marketplace. Marketplace plans cover pre-existing conditions with no health questions. Private plans ask a few health questions instead, and that is the trade: approval is not guaranteed, but approved applicants are typically rewarded with lower pricing. For a generally healthy person, those questions are often the reason a private plan can cost less.
Why full, honest answers matter
- The carrier decides, not us. Approval is the carrier's decision, and it is made from what your application says. We cannot approve you, and we would never tell you how to answer.
- An answer left out does not change your health. It only means the decision was made on an incomplete picture. You want the carrier's yes to be a yes about the real you.
- If a question is unclear, ask before you answer. Do not guess. Send us the question and we will help you understand what it is asking.
Picture it
It is late, you are filling out an application on your own, and a question asks about a medication you take every month. You are not sure whether it counts. You either guess, or you close the tab and decide private coverage must not be for people like you.
Now picture the other version. Before any application, you send us your list: your doctors, your medications, anything you are being treated for. We look at which plans fit and check that your medication is covered. On some private plans we offer, a quick suitability check comes first, so you know where you stand before any application is filed. Maybe a private plan works. Maybe the Marketplace fits better this time, and we tell you so. Either way, you never had to guess.
What to have ready
- Your doctors. Every doctor, specialist and hospital you want to keep, with the city they practice in. We check them by name against each plan's network.
- Your medications. Each one by name. Prescription benefits differ by plan, so tell us the drug and we will match you to a plan that actually covers it before you enroll.
- Your health history. Any condition, diagnosis or treatment the questions might ask about, so you can answer from notes instead of memory.
- Everyone on the application. If your spouse is applying too, the suitability check covers both of you.
If a private plan says no
A no on a private application is not the end of the road. Marketplace plans always cover pre-existing conditions, with no health questions, during Open Enrollment or after a qualifying life event. And some private plans are limited medical, which is not the same as major medical, so we label which is which. See ACA and private plans side by side, or read limited medical vs. major medical.
This is general education, not tax advice and not a guarantee of coverage or approval. Health questions, underwriting, pricing and eligibility depend on the carrier, the plan, your state and your health history.