Across the United States, many people are in need of health insurance. For many Americans with health-related problems, the process is daunting because insurance companies often define those problems as pre-existing conditions. Why is this an issue? Read on to learn more about pre-existing conditions and health insurance.


A pre-existing condition is a health problem that existed before enrollment in a health insurance plan. The term refers to any known illness, injury, or other health condition that was recorded in the medical record of a person before he or she secured insurance. This includes, but is not limited to physical and mental health conditions such as heart disease, diabetes, cancer, asthma, depression, etc., all that are considered long-term or chronic conditions.


Understanding pre-existing conditions is important because insurance companies consider them as they evaluate applications for coverage–historically, they could deny coverage or increase the cost of premiums based on such conditions, leaving many individuals without health insurance coverage. That said, the Affordable Care Act (ACA), which was signed into law by President Barack Obama in 2010 and went into effect for plans that began on January 1, 2014, states that it is illegal for health insurance companies to refuse coverage or to charge more if one has any pre-existing conditions. The law further mandates that health insurers are not allowed to limit health benefits or refuse to cover treatment for any pre-existing condition (once coverage begins).


There are health insurance plans that still exclude pre-existing conditions. These include short-term medical plans, Farm Bureau plans, and some other non-ACA-compliant health plans. Medigap plans can also exclude pre-existing conditions if you haven’t had continuous coverage prior to enrolling. Insurance companies with these types of plans are permitted to deny coverage or charge higher premiums for having pre-existing conditions, and can even exclude pre-existing conditions from coverage altogether. These plans are considered qualifying health coverage plans and are useful in limited cases, such as when an individual wants health coverage, but is unable to afford an ACA-compliant plan.


If you want to learn more about your health insurance options, there are many helpful resources available to you. Contact your state insurance department or search online to get more information.



“Affordable Care Act”


“Pre-Existing Conditions”


“Coverage for pre-existing conditions”


“How to get health insurance with pre-existing conditions in 2021”

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