Can I get coverage if I have a pre-existing condition? (2024)

FAQs

Can I get coverage if I have a pre-existing condition? ›

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can't charge women more than men.

Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

Critical illness policies are not regulated by the Affordable Care Act (ACA). So insurers that offer these plans can exclude pre-existing medical conditions or reject an applicant based on medical history. They also impose waiting periods before benefits can be paid for a new medical condition.

What are pre-existing medical conditions? A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.

Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.

Pre-existing condition

A health condition that exists before the date that new health coverage starts. Under the ACA, health insurance companies can't refuse to cover you or charge you more if you have a pre-existing condition.

Denial code 51 is used to indicate that the services being billed for are not covered by the insurance provider because they are related to a pre-existing condition.

Pre-existing diseases or PED is a kind of chronic or long-term medical condition which already exists at the time when one buys a health insurance. The most common examples of pre-existing diseases are: High blood pressure.

How do you avoid pre-existing condition exclusion? ›

If your health plan is fully compliant with the ACA and obtained in either the individual/family market or the employer-sponsored market, you no longer need to worry about pre-existing condition exclusion periods.

Pre-Existing Diseases (PED) Waiting Period

Examples of some pre-existing diseases are thyroid, hypertension, and diabetes. Generally, the waiting period for pre-existing disease in health insurance plans is 1-4 years.

If you are joining a fully insured group health plan in California, the maximum exclusion period is 6 months. If you are joining a self-insured group health plan, the maximum exclusion period is 12 months. You will receive credit toward your pre-existing condition exclusion period for any previous continuous coverage.

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

This means that individuals cannot be denied insurance coverage due to pre-existing conditions. Under the Affordable Care Act (ACA), guaranteed issue is a fundamental provision that ensures individuals with existing health issues have the same access to insurance as those without such conditions.

Failure to disclose pre-existing conditions not only jeopardizes the chances of successful claims but may also lead to the cancellation of the policy in extreme cases.

Due to the added risk health problems create for insurers, some pre-existing conditions can raise your premium or even disqualify you entirely from certain types of life insurance. A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma.

Yes. Medicare Advantage (MA) plans won't reject your enrollment if you have a preexisting condition. But since MA plans are offered by private insurance companies, coverage levels and costs can vary from company to company.