How Do Preexisting Conditions Work With Modern Health Insurance?

Before the ACA was passed, it was difficult to find health insurance providers who would cover a serious pre-existing condition, such as cancer, diabetes, or asthma - or any pre-existing condition at all.

​In many cases, you couldn't even get a policy if you had a major pre-existing condition. If you did, it would typically either exclude coverage of said condition or you'd have to pay a substantially higher monthly premium.

But how are pre-existing conditions handled by health insurance policies today?

Health Insurance Now Covers Preexisting Conditions
One of the biggest changes to major medical insurance over the last decade has been the mandate by federal law that all insurers accept people with pre-existing conditions, cover those conditions, and not charge higher premiums to these customers.

A transition program, the Pre-existing Condition Insurance Plan, was used up till 2014, for those who had been without health insurance for 6 months or more, had a pre-existing condition, and had been denied coverage. And there are a few grandfathered plans still today that don't cover pre-existing conditions - where the policy holder chooses to keep such a plan in order to maintain lower rates or for other reasons. But today, almost all plans cover all conditions regardless of when they began or what they are.

Also, marketplace insurers are not allowed to place a coverage cap, either yearly or lifetime, on your plan because you have a pre-existing condition, nor for anyone who comes down with a particular condition after signing up.

Pre-existing Conditions & Covering Kids
Both Medicaid and CHIP (Children's Health Insurance Program) plans, like many other health insurance plans, cannot deny coverage based on a pre-existing condition. That's great news if you're looking for health insurance for children or for the whole family!

But that's not where it ends. Pregnancy is also considered a pre-existing condition (if you're already pregnant when you sign up for health insurance), and thus, cannot be the basis for denial of cover or of higher premiums. And your policy must cover the costs of pregnancy and of giving birth from when you enroll and going forward.

Finally, if you have a health insurance policy that covers you (and your spouse if you have one) but, obviously, not yet your child who is still unborn - you can add health coverage to include your child once he or she is born. You can do this even outside the open enrollment time limits because childbirth entitles you to a special enrollment period. This same setup applies to those who adopt a child as well - you get a special enrollment allowance from the date of adoption.
And even if you sign up for additional health insurance as late as 60 days after giving birth or adopting a child, your coverage can begin at the date of birth or adoption.

Choosing Your Health Plan
Although pre-existing conditions won't disallow you insurance or up the premiums, they may affect which type of policy is best for you.

If your condition means your annual healthcare costs will be high, it makes sense to buy a low deductible, low copay plan that will reduce your out of pocket expenses to the bare minimum. That will mean paying higher premiums for a better plan, but you'll still likely save more money.

For help in deciding which insurance policy is right for you, contact Summerlin Benefits Consulting to speak to an agent!