Pre-Existing Condition Rules

Some health conditions require the patient to access more medical care. If you have specific health needs and are searching for health insurance, you might wonder how your pre-existing condition can impact your coverage. What exactly is a pre-existing condition, and how does it work when searching for health insurance coverage?

According to a 2019 study, approximately 25% of adults under 65 have pre-existing conditions. A pre-existing condition is a health condition, illness, or injury you are aware of before applying for health insurance coverage. The majority of these issues are considered long-term or chronic. Here are some examples of pre-existing conditions: 

  • Epilepsy 
  • Asthma 
  • Sleep apnea 
  • Cancer 
  • Diabetes 

Before the 2010 passing of the Affordable Care Act (also known as Obamacare and ACA), pre-existing conditions could result in health insurance companies denying coverage for individuals or charging significantly higher premiums. This is because your insurance company expects that your pre-existing conditions will eventually cost them more money in treatments and procedures.

Your health insurance policy will specifically list pre-existing conditions and coverage on your paperwork. Make sure to read the details of any plan you are considering and how the plan covers your current medical conditions or health problems. Not all health plans offer coverage for pre-existing conditions; however, plans through the Marketplace will.

Other factors can affect your health care costs besides pre-existing conditions. These include your plan, whether you use tobacco, family size, and age.

In sum, current law states you cannot be charged more or denied for your pre-existing health condition. However, there may be health plans that are a better fit for you than others for your pre-existing medical condition. For example, if you get regular medical care or treatments, a plan with a higher monthly premium and a lower deductible might best meet your needs.

When choosing a health plan, it is essential that you consider your own healthcare needs. For example, if you require more frequent care due to ongoing medical conditions, those specific needs could impact your chosen plan, but you cannot be denied coverage due to them.

Tom Miroballi, Independent BCBS Agent, will help you evaluate and select the right insurance package to make your healthcare work for you. Before signing up, Tom will explain the terms, rules, or whether the plan will cover something.

Affordable health insurance is just one call away! Give Tom a call at 630-863-3477 or email him today!