Can I get coverage if I have a pre-existing condition? (2024)

FAQs

Can I get coverage if I have a pre-existing condition? ›

The impact of pre-existing conditions on health insurance

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. They cannot limit benefits for that condition either.

You can still get health insurance if you have pre-existing medical conditions, but it is unlikely your policy will provide cover for them. The type of underwriting of your health plan determines whether your pre-existing conditions will be covered in the future.

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.

Your policy may delay coverage for pre- existing conditions for up to one year after your policy starts. This is called an “exclusion period.” This period is shorter if your previous insurance ended within the last two months.

Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. 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.

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.

The ACA bars use of pre-existing conditions

The ACA complements the Genetic Information Nondiscrimination Act (GINA) which prohibits discrimination by most health insurance plans and employers based on genetic information such as an inherited genetic mutation associated with an increased risk of cancer.

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.

Why are pre-existing conditions not covered? ›

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.

Moratorium underwriting

They may also speak to your doctor. We don't normally cover pre-existing conditions, which is any disease, illness, or injury you've had symptoms, medication, tests, treatment or advice for in the five years before you take out cover.

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.

In the past, people could be barred from getting a health plan because of a pre-existing condition. Thanks to the Affordable Care Act, pre-existing conditions are no longer grounds for refusing to sell someone insurance.

To cope with treatment expenses, most opt for health insurance plans. They cover pre-existing diseases like diabetes, high blood pressure, etc. However, it is important to note this coverage only comes after you finish a waiting period and is subject to other terms before you can claim coverage.

So what do health insurance companies mean by “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)

Denial code 51 is used to indicate that the services being billed for are not covered by the insurance provider because they are related to a pre-existing condition.

You cannot be denied coverage based on preexisting conditions.

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.

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.