Can I be denied health insurance if I have a pre-existing condition?
If you are enrolled in a plan since 2010, then your insurer can’t legally deny you coverage or charge you higher premiums because you have a pre-existing condition.
The Affordable Care Act, passed in 2010, made it illegal for insurers to deny you coverage or charge high rates for pre-existing conditions. Additionally, if your health changes and you develop a chronic medical condition while enrolled in a health plan, your insurance carrier cannot raise your rates because of that medical condition. However, annual premium increases may apply to your plan for other reasons.
If, however, you are enrolled in a plan that started before 2010, you have a “grandfathered plan”. These plans can cancel your coverage or can charge you higher rates due to a pre-existing condition.
If you are exploring coverage options, it’s important to be aware of any potential changes to health care law that could impact how pre-existing conditions are covered.
Is pregnancy considered a pre-existing condition?
If you get pregnant before enrolling in a health plan, you cannot be denied coverage or charged more due to pregnancy. Coverage for pregnancy and delivery begins from the day you enroll in a plan.
Is there health insurance for pre-existing conditions?
Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment. However, there may be health plans that are a better fit for you than others if you have a chronic, or pre-existing, medical condition.
For example, if you need regular medical care, surgeries, or treatments, then a plan with a little higher monthly premium and lower deductible may provide you with the coverage you need and help you manage more predictable costs.
Could my health plan have a pre-existing condition waiting period?
No. There are no waiting periods for medical plans, including for pre-existing conditions.
When choosing a health plan, consider your medical needs. If you have a chronic or ongoing medical condition that requires more frequent care, those needs could affect the type of plan you choose, but you cannot be denied coverage or charged more due to a pre-existing condition.
FAQs
A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.
What counts as a pre-existing medical condition? ›
A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.
How far back is a pre-existing condition? ›
It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance. For example, you might take out a policy and then go and see your GP about some back pain you've been experiencing.
Can you be denied for pre-existing conditions? ›
Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.
Does being pregnant count as a pre-existing condition? ›
According to Healthcare.gov, pregnancy is not considered a pre-existing condition. So if you were pregnant at the time that you applied for new health coverage: You can't be denied coverage due to your pregnancy. You can't be charged a higher premium because of your pregnancy.
Which of the following best describes a pre-existing condition? ›
A pre-existing condition is any health problem, like diabetes, or cancer, that you had before the date you applied for insurance. Insurers cannot refuse to cover treatment for your pre-existing condition or charge you more under the ACA.
What is the time frame for pre-existing conditions? ›
The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.
Will insurance cover pre-existing conditions? ›
After serving any applicable waiting periods on your health insurance policy, you can begin to claim benefits in your policy – including any related to your pre-existing condition.
What is the difference between existing and preexisting? ›
Existing is a certain thing that is present nowadays and can be seen in present time. Preexisting refers to something that has existed a long time ago, and forgotten, and has existed once more in our present time.
How do you know if a condition is pre-existing? ›
A medical illness or injury that you have before you start a new health care plan may be considered a pre-existing condition. Conditions like diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, may be examples of pre-existing health conditions. They tend to be chronic or long-term.
If your health plan is fully compliant with the ACA and obtained in either the individual/family market or the employer-sponsored market, you no longer need to worry about pre-existing condition exclusion periods.
Is a bad back a pre-existing medical condition? ›
Is back pain a pre-existing medical condition? Yes.
Is high blood pressure a pre-existing condition? ›
In the health insurance world, a pre-existing condition is any injury, sickness or condition that exists before the date an insurance policy takes effect. Examples include asthma, diabetes, anxiety, depression, high blood pressure, high cholesterol and so on.
Does a pre-existing condition have to be diagnosed? ›
How are pre-existing conditions determined? A pre-existing condition is a health issue that required diagnosis or treatment prior to an applicants' enrollment in a health plan.
Do pre-existing conditions affect life insurance? ›
Due to the added risk health problems create for insurers, some pre-existing conditions can raise your premium or even disqualify you entirely from certain types of life insurance. A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma.
Is it a pre-existing condition if it hasn't been diagnosed? ›
A pre-existing condition for cat or dog insurance is typically an illness or injury your pet shows signs of any time before the end of your pet insurance waiting period. This may include conditions not yet diagnosed by a veterinarian.
Are allergies considered a pre-existing condition? ›
A pre-existing condition might be mild – for example, seasonal allergies or acne treated with simple medications. Or it could be more serious or require more costly treatment – such as diabetes, heart disease, or cancer.
How long can an insurer exclude coverage for a pre-existing condition? ›
The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.
Is high blood pressure considered a pre-existing condition? ›
A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma. Previous injuries might be considered pre-existing conditions, depending on their severity and any lasting effects.
