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How Do Pre-Existing Condition Affect Health Insurance?

A health condition that has been there before you applied for or registered a new health insurance policy is considered a “pre-existing condition.” Generally, insurers describe what institutes a pre-existing condition. Some pre-existing conditions are obvious, like heart disease, cancer, diabetes, high blood pressure, or asthma.

Insurers commonly conclude the presence of a pre-existing condition from the applicant’s current health status. However, a healthy applicant can be considered to have a pre-existing condition assumed from past health problems or evidence of treatment for a specific condition.

Can You Get Coverage If You Have a Pre-Existing Condition?

Yes, you can get insurance coverage even if you or a family member has a pre-existing condition. However, this hasn’t been the case.

Before the Affordable Care Act (“ACA” and Obamacare) was passed in 2010, insurance companies used to decline to offer coverage for clients with pre-existing conditions. They could charge higher premiums to those with pre-existing conditions or decline their health insurance applications altogether. If you are registered in a plan as of 2010, your insurer cannot lawfully charge you higher premiums or deny you coverage for pre-existing conditions.

The 2010 Obamacare ACA (Affordable Care Act) made it unlawful for insurers to charge high rates or deny coverage for pre-existing conditions. Moreover, if you get a chronic medical disease while already registered on a health plan, your insurer cannot raise the rates due to that chronic medical condition. Also, your gender cannot be determinant of cost. This provides equality between people lucky to have good health and those who haven’t been lucky.

However, if you enrolled in a plan that began before 2010, you probably have a “grandfathered plan,” the only pre-existing coverage rule excluded. Grandfathered plans are health coverage plans that existed before the passage of the Affordable Care Act (“ACA” and Obamacare) in 2010.

Grandfathered plans can charge you higher rates based on your health status or gender. It may also not cover preventive health services and can cancel your coverage because of a pre-existing condition. If you have a grandfathered plan and have pre-existing conditions that you want the insurance to cover, here are two options:

  • Change to a marketplace plan to cover them during open enrollment.
  • Purchase a marketplace plan separately from open enrollment when the grandfathered plan ends, and you’ll be eligible for a special enrollment period.

Ensure you have chosen a coverage plan that best meets your needs and that of your family when searching for coverage options. Read the details of any plan you are considering thoroughly to ensure that your plan covers health problems or medical conditions you have. It is also best to understand any changes in health care law that can impact coverage of pre-existing conditions.

Do Non-ACA-Compliant Policies Consider Pre-Existing Conditions?

If you or your family member has a pre-existing condition, there are two main exclusions wherein health insurers might not cover pre-existing conditions.

Grandfathered Health Plans

If you get coverage for yourself or your child with a pre-existing condition under union’s or employer’s group health coverage, ensure you check with the plan administrator to know whether the plan is “grandfathered”.

Through the law, these health plans can provide similar benefits today to those before the 2010 Affordable Care Act. They can exclude or limit coverage for pre-existing conditions.

Short-Term Medical Plans

Short-term medical plans are excused from the law needing insurance coverage for pre-existing conditions. Even the few short-term medical insurers who agree with your application could enforce a waiting period before they cover the treatment associated with a pre-existing condition.

A short-term medical plan can be effective from three months to one year and might renew for up to three years.

However, due to its somewhat short time, a short-term plan may not assist you in paying for treatment related to pre-existing conditions, even if the insurer accepted your application.

Is Pregnancy Covered or Considered a Pre-Existing Condition?

If you are pregnant when applying, the insurer can’t charge you more or reject you because of your pregnancy. After you’re enrolled, pregnancy and childbirth get fully covered from the day your plan starts.

If you’ve got a 2022 health plan and give birth after you enroll:

  • Your child’s birth makes you eligible for a special enrollment period, which means you can change plans or enroll outside the yearly open enrollment period.
  • Your coverage may begin from the birth date, albeit enrolling up to sixty days afterward.

Does The Health Plan Coverage for A Pre-Existing Condition Have a Waiting Period?

There aren’t waiting periods for medical plans, pre-existing conditions included. It will work best if you consider your medical needs before choosing a health plan. For example, if you’re a chronic or pre-existing medical condition that calls for more regular care, these needs can affect your chosen plan. However, your insurer can’t deny coverage or charge you more because of a pre-existing condition.

Getting Health Insurance with A Pre-Existing Condition

Finding health insurance is not hard if you have a pre-existing condition. Health insurance compliant with ACA is available from your state’s marketplace and outside the market. Start your search by checking out all the health insurance plans (individual and family) available in your region. Then, answer several queries about your health insurance needs or fill out a questionnaire. Finally, compare the costs and benefits.

You can be asked if you have a family history of diabetes or heart disease, the medications you take, and what/ how many surgeries you’ve had. Other plans require full ‘’underwriting’’ which entails an examination from a health expert and a chain of diagnostic tests to conclude if you qualify for the coverage.

Choosing a health plan these days isn’t based on a pre-existing condition anymore. A health insurer cannot deny you coverage or raise rates for plans if you have a pre-existing condition during enrollment.

However, some health plans might be better than others if you have a pre-existing or chronic medical condition. For instance, if you require medical care often, treatments, or surgery, a plan with a bit higher premium and lower deductible might give you the coverage you require. This can help you manage more expectable costs.

Apart from this if you are interested to know more about How Do Pre-Existing Condition Affect Health Insurance? then visit our Health category.

abdul waheed

Abdul Waheed is a seasoned business blogger, specializing in entrepreneurship and small business management. With over 10 years of experience, he offers invaluable insights and practical guidance to aspiring entrepreneurs, helping them navigate the challenges of starting and growing a successful business.

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