health insurance and pre existing conditions

Health Insurance and Pre-existing Conditions

By Robert Slider

Can I get health insurance with a pre-existing condition?

It’s not uncommon to wonder if you can get health insurance if you have a pre-existing condition. 

In this blog, we will answer the following:

-What is a “pre-existing condition?”

-Can I be denied health insurance if I have a pre-existing condition?

-Will a pre-existing condition result in higher premiums?

-Do non-ACA compliant plans consider pre-existing conditions?

Let’s get right to it …

What is a “pre-existing condition?”

A pre-existing condition is a health problem you had before starting a new health care plan. 

Some examples of pre-existing conditions include:

  • Pregnancy
  • Epilepsy
  • Asthma
  • Sleep apnea
  • Cancer
  • Diabetes

Can I be denied health insurance if I have a pre-existing condition?

Under the Affordable Care Act, which passed in 2010, it is illegal for health insurance companies to deny you coverage or charge high rates for pre-existing conditions. 

If, however, you are enrolled in a plan that started before 2010, you have a “grandfathered plan.” These plans can cancel your coverage or charge you higher rates due to a pre-existing condition. Learn more on this below.

Will a pre-existing condition result in higher premiums?

Under current law, if you’re buying an ACA-compliant individual health insurance plan, insurance companies cannot charge higher premiums due to pre-existing conditions.

Even 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, you still need to compare health insurance plans’ costs and coverage to make sure you are choosing health plan coverage that best meets the needs of you and your family. 

Do non-ACA compliant plans consider pre-existing conditions?

If you or a family member has a pre-existing condition, you should be aware of the two main exceptions in which health insurers may not cover pre-existing conditions.

  • Short-term medical policies. Short-term medical policies are exempt from the law requiring insurance coverage for pre-existing conditions. Even short-term medical insurers that may accept your application may impose a waiting period before they will cover treatment related to a pre-existing condition. 

A short-term medical policy may be effective from 90 to 365 days and may renew for three (3) years. Given its relatively short duration, a short-term policy may not help you pay for treatment of pre-existing conditions even if the insurer accepts your application.

  • Grandfathered plans. Grandfathered plans are health plans that were in place before March 23, 2010. By law, these health plans can offer the same benefits today they provided before the Affordable Care Act. They may restrict or exclude coverage for pre-existing conditions.

Get in Touch With an Experienced Local Insurance Broker

As your local insurance broker, I will help you understand your health insurance options and identify plans that will result in the affordable care you and your family need. Contact me today for a no-cost, no-obligation appointment to assess your needs.

I am licensed in Georgia, South Carolina, Florida, Pennsylvania, and Alabama.

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