Prior to the Affordable Care Act (ACA or Obamacare), health insurance companies often denied individuals from purchasing individual health plans due to pre-existing conditions ranging from acne to more serious illnesses like cancer and heart disease.
KFF estimated that 54 million non-elderly adults had declinable preexisting conditions on the individual market in 2018. Under former rules, insurers would have rejected such coverage or raised premiums accordingly.
Pre-existing conditions are medical conditions that you have had or have been diagnosed with.
Pre-existing conditions refers to any illness, injury or sickness that existed prior to purchasing your health insurance policy. They can range from minor conditions like allergies or asthma that need medication; to serious ones like coronary heart disease, cancer and diabetes. Pre-existing conditions also encompass chronic illnesses like high blood pressure or cholesterol issues that require ongoing management.
Before the Affordable Care Act (ACA) was enacted, those without coverage through either employers or governments faced difficulty finding health insurance that covered preexisting conditions and was fair for consumers – this often meant being denied coverage entirely, being subjected to waiting periods or charged higher premiums which led to unfair practices against consumers that denied families from accessing quality and affordable health care solutions.
Under the Affordable Care Act (ACA), major medical plans cannot exclude preexisting conditions from coverage or charge more than their standard rate based on these preexisting conditions. This regulation applies to plans incepting post 2014 as well as plans in effect prior to 2014 that renew or amend.
There are exceptions, however. If you become pregnant prior to enrolling in a health plan, this condition will be considered pre-existing and excluded from coverage. Also, if an existing condition such as high blood pressure is uncontrolled and not being managed accordingly, your insurance company may raise your rates to cover its treatment.
Pre-existing conditions can also influence eligibility for health coverage if you purchase an individual or family plan on the individual market, or one not covered under minimum essential coverage rules such as those mandated by ACA. Plans differ in how they treat pre-existing conditions so it’s wise to read carefully through any policy before purchasing one.
No matter the type of health insurance plan you select, it’s always advisable to read your policy thoroughly and with care. This is particularly important with policies not regulated under the ACA or considered minimum essential coverage, such as short-term health plans, fixed indemnity plans, healthcare sharing ministry plans, direct primary care plans or Farm Bureau plans in certain states.
Even without pre-existing conditions, it’s still easy to find affordable health insurance by shopping around and using online tools to compare policies. If you do have pre-existing conditions, consider applying for guaranteed acceptance health insurance like CoverMe Guaranteed Issue Enhanced. With this option, you will know in advance whether or not your policy will approve you – making decision easier when considering health coverage options. You can even apply quickly with our convenient application tool – start your search today.
Pre-existing conditions are conditions that you have had or have been diagnosed with.
Since 2014 when the Affordable Care Act (ACA) took effect, Americans seeking individual health insurance policies no longer face higher premiums or denial due to pre-existing conditions.
Pre-existing conditions refers to any illness, injury, or medical issue that existed prior to signing for a health insurance policy. These could range from chronic issues such as asthma and diabetes to acute ones like an unexpected injury or trauma; pre-existing conditions could even include headaches and frequent bouts with flu.
Most insurance companies utilize two definitions to establish pre-existing conditions: objective standard definition (any condition for which medical advice or treatment was sought prior to enrolling in new health insurance coverage), and prudent person definition. Both measures take into account any medical issue for which a responsible, prudent individual would have sought care in accordance with industry practices.
The Affordable Care Act has made it unlawful for insurance companies to deny you coverage or charge you more because of pre-existing conditions, both new and existing policies alike. Furthermore, insurers cannot exclude pre-existing conditions from coverage except in cases of severe and uncontrollable medical issues.
Prior to the ACA, most pre-existing conditions were excluded from health plans for an exclusion period ranging from 12-18 months or permanently in some instances, forcing you to wait before receiving treatment for them. Even after this exclusion period had expired, certain treatments or medications might still not be covered, potentially leaving gaps between coverage for your symptoms and actual treatments available to manage them.
KFF research indicates that approximately 82 million adults between 55 and 64 have preexisting conditions, such as cancer or heart disease, high blood pressure, depression anxiety or obesity. As these individuals move into retirement or changing jobs they risk losing employer-based coverage making it hard to find affordable healthcare through individual markets or via direct contracting.
Pregnancy should not be considered a pre-existing condition; most health insurance plans cover it because it’s part of normal life and one of the primary concerns for women. If seeking pregnancy-related care, your insurer may require you to undergo a waiting period prior to covering its costs; similar to how high blood pressure treatments may work after waiting periods are complete; similarly asthma, diabetes and anxiety cases often fall within this same category.
