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.
How do insurance companies determine pre-existing conditions? ›
How are pre-existing conditions determined? A pre-existing condition is typically when you have received treatment or diagnosis before you enrolled in a new health plan.
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.
Does a pre-existing condition have to be diagnosed? ›
A pre-existing condition is a health problem that already existed (officially diagnosed or just symptomatic) before you apply for a health insurance policy or enroll in a new health plan. Practically any medical issue could fall under the umbrella of a pre-existing condition in the pre-ACA days.
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.
Is a broken bone a pre-existing condition? ›
A pre-existing condition can refer to the following: A past injury or illness that you have already recovered from (such as a broken ankle from your youth) Symptoms which you have yet to seek medical advice, treatment or consultation (such as pains, lumps, bleeding etc.)
Why don't insurance companies cover pre-existing conditions? ›
The Affordable Care Act and Pre-Existing Conditions
One of the hallmarks of the Patient Protection and Affordable Care Act signed into law in March 2010, was the elimination of pre-existing condition requirements imposed by health plans. This was phased in first for children, and then for adults.
In the world of personal injury law, there's a principle known as the “eggshell plaintiff” rule. This rule essentially states anyone injuring another person is responsible for all the consequences, even if the person had a pre-existing condition that worsened the injuries.
When did pre-existing conditions end? ›
These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.
Does Medicare cover pre-existing conditions? ›
Yes. When you sign up for Original Medicare, any preexisting condition will be covered immediately. However, you'll still be responsible for all out-of-pocket expenses like deductibles, copayments and coinsurance.
What is the difference between acute onset of pre-existing conditions and pre-existing conditions? ›
Pre-existing conditions are the medical issues themselves, while the acute onset of pre-existing conditions is the sudden and unexpected recurrence of a pre-existing condition.
Is arthritis a pre-existing condition? ›
A pre-existing condition is an injury or illness that was already present before the work injury. It may or may not have healed completely and is not necessarily related to your job. Examples of common pre-existing conditions that may affect your workers' comp claim include: Arthritis.
