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.

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.

A pre-existing condition is any illness or condition a patient has prior to obtaining insurance. In the past, people could be barred from getting a health plan because of a pre-existing condition. Thanks to the Affordable Care Act, pre-existing conditions are no longer grounds for refusing to sell someone insurance.

Private health insurance is usually available for people with pre-existing conditions, but exclusions will be applied to your policy.

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.

It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance. For example, you might take out a policy and then go and see your GP about some back pain you've been experiencing.

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.

No. Marketplace health plans are not allowed to charge you more based on your health status or pre-existing condition. However, some plans, such as short-term policies, that are sold off the Marketplace might turn you down or charge you more based on your health status or pre-existing 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.

In the health insurance world, a pre-existing condition is any injury, sickness or condition that exists before the date an insurance policy takes effect. Examples include asthma, diabetes, anxiety, depression, high blood pressure, high cholesterol and so on.

How do life insurance companies know about pre-existing conditions? ›

Depending on the policy you apply for, you may also have to take a medical exam to confirm your health status and determine eligibility and rates. The exam is free to you and usually includes height and weight checks, basic tests, and a health questionnaire.

Original Medicare ( Part A and Part B ) has helped cover preexisting conditions since it began in 1965. And thanks to the Affordable Care Act signed in 2014, there are no additional costs for Original Medicare coverage if you have preexisting conditions.

A pre-existing condition, as defined by the Department of Health and Human Services, includes any injury or illness — physical or mental — that you may have experienced before your insurance claim.

If you are enrolled in a plan since 2010, then your insurer can't legally deny you coverage or charge you higher premiums because you have a pre-existing condition. The Affordable Care Act, passed in 2010, made it illegal for insurers to deny you coverage or charge high rates for pre-existing conditions.

Types of Waiting Period in Health Insurance

Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 4 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 4 successful years with the insurer.

Pre-existing conditions exclusion

This type of waiting period can last a maximum of 12 months, unless you're a late enrollee, in which case it can go up to 18 months. It excludes coverage for any conditions that were diagnosed or recommended for treatment in the 6 months prior to your enrollment date.

Pre-existing condition: Code 51 may be assigned when the insurance company determines that the services rendered are related to a pre-existing condition. In such cases, the insurance policy may have specific limitations or exclusions for pre-existing conditions, resulting in a denial of coverage.

Yes. When you sign up for Original Medicare, any preexisting condition will be covered immediately. However, you'll still be responsible for all out-of-pocket expenses like deductibles, copayments and coinsurance.

The Affordable Care Act (ACA), also known as Obamacare, requires insurance companies to cover individuals with preexisting conditions. The ACA prevents health insurance companies from denying coverage to individuals who have preexisting conditions.

People with pre-existing conditions can still qualify for various life insurance policies. However, they may pay more in premiums because personal health history is a key factor that insurers use to calculate rates.