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My freelance work is organized as a single-member LLC. Since the Affordable Care Act, I have been getting insurance coverage directly from a health insurance provider, with rates equal to those on the exchange. Each year in November, my existing provider sends me a letter in one of two forms:

• "We are willing to continue your coverage under your existing plan for $X"


• "We are discontinuing your existing plan, but we are willing to offer you coverage under this other similar plan for $X"

I am reasonably healthy, so all of that has been fine so far. However, I'm over 50, and so the likelihood of chronic health issues climbs with each passing year.

A lot of the ink that has been spilled on the ACA focuses on the insurance rates. My question is about the availability of coverage in the first place.

Suppose I am diagnosed with a chronic medical condition, one needing long-term ongoing treatment and testing:

1. At the annual renewal time, can my existing health insurance provider simply decline to allow me to renew? I'm focusing here on outright denial of coverage, more than "you can renew but your monthly premium is on par with the GDP of Iceland", which AFAIK is an option that the provider could take.




2. If yes, how frequently does this occur?




3. BONUS: Also, if yes, how do the pre-existing condition rules under ACA affect my ability to get insurance from another provider? (UPDATE: HHS states that pre-existing conditions should not block access to insurance, so that's covered)

1. At the annual renewal time, can my existing health insurance provider simply decline to allow me to renew? I'm focusing here on outright denial of coverage, more than "you can renew but your monthly premium is on par with the GDP of Iceland", which AFAIK is an option that the provider could take.

No.

2. If yes, how frequently does this occur?

For the time being it's illegal

3. BONUS: Also, if yes, how do the pre-existing condition rules under ACA affect my ability to get insurance from another provider?

As far as I'm concerned the only consumer protection in the hundreds and hundreds of pages of ACA is the prohibition on pre-existing condition exclusions and forced market pooling.

Markets will be different across the country. Political meddling is sure to affect health markets in the years to come. But for right now, there are no pre-existing condition exclusions and no underwriting. Every year you can shop your policy, your carrier can't cancel you; it can decide to withdraw from a market, it can have provider attrition out of its network; it can reprice things, but it can't focus on your specifically.

Where you should be concerned is the changes under the covers of the policy. Did the carrier change drug formulates, is your doctor still in the network, etc. An individual has almost no reason not to lightly shop the market each year.

Also, if yes, how do the pre-existing condition rules under ACA affect
my ability to get insurance from another provider?

As long as you meet the ACA definition of continuous coverage you don't have to worry about pre-existing conditions. You will be covered as you move between policies within the same insurance company, or if you change insurance companies, or if you switch from one through the exchange to one through an employer. This part of the ACA is considered a provision that people generally like.

as to question 1:

At the annual renewal time, can my existing health insurance provider
simply decline to allow me to renew? I'm focusing here on outright
denial of coverage, more than "you can renew but your monthly premium
is on par with the GDP of Iceland", which AFAIK is an option that the
provider could take.

The insurance company is making a business decision regard policies, rates and availability in state X. Therefore each open season you may find that your plan may not be available, or the company may make changes that will cause customers to seek out other options. There are state regulations in addition to ACA regulations that have to be considered regarding the rates and changes, but the fact you have policy Y this year doesn't mean you will have policy Y next year.

Because of the rules regarding plans that meet the tiers in the exchange, and the elimination of rules regarding lifetime limits and pre-existing conditions they are limited in their ability to say customer Z we won't insure you anymore.

The question is legit, but as with stocks, past performance is no guarantee of future results. A single political event renders past behavior obsolete.
Specifically, the repeal of the mandate greatly changed the customer base. With no penalty at all, healthy people became far less likely to pay for insurance. The full effect of this hasn't been felt yet.

On the other hand, the GOP has stated that they will have a plan better than any plan on the planet and better than any existing plan offered by the Dems. They say this with such sincerity, it must be so.