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 pre-existing condition is a medical issue that affects an individual prior to their health insurance going into effect. Pre-existing conditions are usually long-term and chronic in nature.
What are preexisting condition responses? ›
A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts.
What counts as a pre-existing 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.
What is considered an existing condition? ›
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.
What is a pre-existing condition quizlet? ›
Definition. HIPAA has defined pre-existing conditions to be health issues that have existed, treated of diagnosed within the last 6 months prior to employment.
Can I be denied coverage for a preexisting condition? ›
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.
What are the most common pre-existing conditions? ›
Pre-existing conditions were based on a modified version of the Kaiser Family Foundation (KFF) list of common “declinable medical conditions” maintained by more than half of insurers,3 which included HIV/AIDS; lupus; alcohol and drug abuse (excludes tobacco use); mental disorders (eg, depression, bipolar disorder); ...
How long ago is a pre-existing condition? ›
A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.
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.
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.
A serious pre-existing condition is one that may require intensive medical intervention to treat or manage; or have high risk of future complications or recurrence, and therefore may require prolonged treatment.
What if pre-existing conditions are not declared? ›
Failure to disclose pre-existing conditions not only jeopardizes the chances of successful claims but may also lead to the cancellation of the policy in extreme cases.
What is a pre-existing condition limitation? ›
A pre-existing condition exclusion period is a window of time, after a health plan takes effect, when a pre-existing condition (or multiple pre-existing conditions) will not be covered by the plan.
What is considered a pre-existing condition? ›
Pre-existing conditions are health conditions, or related signs, symptoms and events that occur or exist before the start of your policy (or start of an upgraded policy). It is relevant to health insurance because pre-existing conditions are normally ineligible for cover under our health insurance policies.
What is the new definition of pre-existing disease? ›
Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and I or were diagnosed, and I or for which medical advice I treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter.
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.
Which of the following best describes a preexisting condition? ›
A preexisting condition is an illness or health condition that existed prior to applying for health or life insurance.
What does preexisting mean? ›
If something's preexisting, it was already there — it existed earlier. Someone might offer you a babysitting job, but if you have a preexisting agreement to watch your little brother that night, you'll have to turn it down.
What is the meaning of existing condition? ›
Existing Condition means the condition of the Premises, “as-is”, on the date hereof. Sample 1Sample 2. Existing Condition means the initial condition of a project site prior to the proposed.
What is a preexisting condition for pet insurance? ›
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.
