Health Insurance Options for those with Pre-Existing Conditions

One of the most controversial American health care topics concerns pre-existing conditions and health insurance. A pre-existing condition is basically a medical or health condition that somebody is suffering from when they apply for health insurance. Health insurance companies don’t like to provide people with a pre-existing condition with an insurance plan since they’re considered to be high-risk patients.

Therefore, it’s seen to be in the insurer’s best interests if they deny coverage to these high-risk patients. However, they may provide the person with health coverage, but could impose a waiting period on them before the coverage starts. They may also charge higher out-of-pocket expenses and/or higher monthly premiums.

Just about anything could be considered to be a pre-existing condition, such as asthma, heart disease, cancer, high blood pressure, and type 2 diabetes etc. These are generally chronic health problems which affect quite a large portion of Americans. However, some relatively minor health conditions can also be classified as pre-existing conditions, including previous injuries and things such as hay fever.

There is good news on the horizon though for Americans as the new Affordable Care Act (ACA) will rectify this situation. Starting in 2014, insurance companies won’t be able to turn anybody down for health coverage due to a pre-existing condition. A similar law was already implemented in September of 2010 when it was ruled that children under the age of 19 can’t be denied coverage on their parents’ due to a pre-existing condition. Also, they can’t insure a child and then exclude treatments that are needed for a pre-existing condition.

However, until 2014, adults can see find it difficult to find that pre-existing conditions and health insurance don’t always mix well. Some people may be provided with insurance, but insist on excluding coverage for the pre-existing condition for a certain period of time. Depending on state laws, this exclusion period could last for up to 18 months. This means that all claims related to the pre-existing condition, such as medications and doctor visits could be turned down.

If you have an employer-sponsored health plan it’s possible that you could have an exclusion period for a pre-existing exclusion if you received treatment for it in the six months prior to joining the plan. Consumers are also protected by things such as HIPAA (Health Insurance Portability and Accountability Act). This states that some health plans can’t deny coverage or charge higher rates due to your health condition. It also usually enables people the right to renew their health policy regardless of their health condition. HIPAA doesn’t apply in every situation though.

There is also something called creditable coverage which means you’ve been insured and the coverage hasn’t been interrupted for a time of 63 days or longer. If you’ve had creditable coverage then a new health plan cant’ place a pre-existing condition exclusion on you. This is important for people who are changing health plans for reasons such as changing jobs. It guarantees that they won’t be excluded as long as they haven’t gone without health insurance for a period of 63 consecutive days.

Get a free insurance quote right now!


Partner logo Partner logo Partner logo Partner logo Partner logo Partner logo Partner logo Partner logo