Why Pre-Existing Conditions Matter in Insurance - MIUSA (2024)

FAQs

How can a pre-existing condition affect your insurance coverage? ›

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.

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy.

It's in their best interest, therefore, to exclude people with pre-existing conditions (or make the coverage unappealing to them), impose a waiting period before coverage starts, or charge higher premiums and out-of-pocket expenses to cover people with pre-existing conditions since those people are likely to cost the ...

A pre-existing condition exclusion period limits the number of benefits that an insurer has to provide for specific medical conditions and does not apply to medical benefits afforded by a health insurance policy for other types of care.

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.

Does Medicare Advantage cover preexisting conditions? Yes. Medicare Advantage (MA) plans won't reject your enrollment if you have a preexisting condition. But since MA plans are offered by private insurance companies, coverage levels and costs can vary from company to company.

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.

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.

A pre-existing condition could be known to the person – for example, if she knows she is pregnant already. People might also apply for coverage when they unknowingly have an undiagnosed condition – for example, tumor cells might be growing within but won't be diagnosed until months or years later.

Pre-existing conditions can make it more difficult and expensive to get life insurance, but even if you have a chronic or terminal health problem, you can likely find a policy you qualify for if you shop around.

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.

Obesity is considered a pre-existing condition under the Affordable Care Act (ACA). So, as with all pre-existing conditions, insurance companies cannot make people with high BMIs pay more in premiums.

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.

Pre-Existing Diseases (PED) Waiting Period

Examples of some pre-existing diseases are thyroid, hypertension, and diabetes. Generally, the waiting period for pre-existing disease in health insurance plans is 1-4 years.

Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy. It's a feature only available with certain comprehensive package plans that include trip cancellation/trip interruption.

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.

While most travel insurance policies exclude pre-existing conditions from medical expenses and evacuation coverage, you may be able to obtain coverage with a pre-existing conditions waiver.

Many insurance policies might not cover a pre-existing condition. For example, if you had cancer in the past, the critical illness policy might not cover cancer if it comes back. But it might cover another critical illness, like a heart attack or stroke, that occurs while you have the policy.