Heath Insurance with Pre-Existing Conditions (Medicare)

What You Should Know About Getting Health Insurance with Pre-Existing Conditions

Pre-existing conditions are illnesses or injuries that you have had prior to the beginning of your new health plan. Asthma, cancer, diabetes, depression, and sleep apnea are some of the pre-existing health conditions. They can be chronic or long-term.

Before the passage of the Affordable Care Act (ACA), an insurance provider will have to check your application for enrollment to see if you have a pre-existing condition.

If you have any, they could reject your application or offer coverage at higher rates. With ACA, it is illegal for health insurance companies to deny you medical coverage or give you inflated rates after learning that you have a pre-existing condition.

Examples of Pre-existing Health Conditions

health insurance pre-existing conditions
Health insurance with pre-existing conditions

Some medical conditions considered pre-existing include:

  • Acne
  • Anxiety
  • Asthma
  • Atherosclerosis
  • Arteritis
  • Bipolar disorder
  • Various forms of cancer
  • Diabetes
  • Dialysis
  • Depression
  • Kidney diseases
  • Muscular dystrophy
  • Organ transplant
  • Substance abuse
  • Sleep apnea

It may also be treated as a pre-existing condition if you have had a back injury after an accident. You can also apply if you are pregnant prior to enrollment. Pregnancy and childbirth coverage starts from the day you participate in a health plan.

If I have any pre-existing condition, will I be denied health coverage?

Heath Insurance with Pre - Existing Conditions
Heath Insurance with Pre-Existing Conditions: If you have pre-existing conditions, make sure to get a plan that covers them.

If you have an enrolled plan since 2010, insurance companies can’t reject your application or charge you with higher premiums if you have a pre-existing condition.

The Affordable Care Act, which was passed in 2010, makes it illegal for insurers to refuse you coverage or burden you with high rates. If you develop any chronic medical condition while in a health plan, your insurance provider cannot increase your premiums.

However, if you are enrolled in a health plan before 2010, you have what is called a “grandfathered plan.” These may terminate your coverage or increase your rates due to a pre-existing condition.

If you are exploring coverage options, you should always be aware of the changes in the health care law to see how it affects those who have pre-existing conditions.

What are the types of health insurance plans that cover pre-existing conditions?

As stated in the federal law, all ACA-compliant plans must cover all pre-existing conditions. This includes those offered by employers and those bought from the Health Insurance Marketplace.

Meanwhile, short-term health insurance or healthcare-sharing ministries, don’t cover pre-existing conditions and don’t have the consumer protections in place. If you want to compare your options among these kinds of plans, you must talk with insurance agents.

Medicaid and CHIP (Children’s Health Insurance Program) also comply with the ACA, meaning they can’t deny you coverage or charge you more premium because of a pre-existing condition. They must be able to cover any pre-existing conditions you have once your health plan commences.

Do all health insurance companies cover pre-existing conditions?

If you have availed a Marketplace plan, your pre-existing conditions will be covered, and it will commence the same day your insurance starts.

Unfortunately, grandfathered plans or the health plans enrolled before March 23, 2010 are not subject to ACA rules. These plans are not sold through the online Marketplace; rather, these were from individual insurance companies, agents, or brokers.

That said, these plans might not include all the rights and protections offered by the Affordable Care Act. If you have a grandfathered plan, your pre-existing condition might not be covered, or they may charge you a higher premium.

Any health policy that is identified as a grandfathered plan must disclose this information to its members. If you are on a group health plan through your employer, you must check in with your HR department if you have a grandfathered plan.

Do I have to pay higher premiums if I have a pre-existing medical condition?

Because of the Affordable Care Act, any Marketplace plans cannot charge you more for your coverage when you have a pre-existing condition.

This applies to individuals who have a plan enrolled through the Marketplace, private insurance through your employer, or have Medicaid or CHIP coverage.

Final Thoughts

Years ago, insurance companies were using a person’s medical history as a way to refuse them coverage or over-charge them with premiums. However, this was deemed illegal after the passage of the Affordable Care Act.

When President Barack Obama signed the Affordable Care Act into law in 2010, insurers can no longer discriminate against people who have pre-existing conditions. This law provides critical protection for patients with pre-existing health issues.

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