Can You Be Denied Coverage? Pre-Existing Conditions 101

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A pre-existing condition is a medical condition that someone has before securing health insurance coverage. These are previously diagnosed conditions that are part of the individual’s medical history. Some examples are epilepsy, cancer, diabetes, sleep apnea, and even pregnancy. Many people worry that such medical conditions will cause insurance companies to deny them coverage. There is also concern that insurance companies will make their customers pay higher rates.

The common thought is that pre-existing conditions will mean you need more medical care. Therefore, it costs insurance companies more to provide you coverage. So, it is understandable that insurance companies might want to charge more or deny coverage. Luckily, there are laws in place to protect consumers, which we will explain in detail below. Read on for more information on how your health report affects your health insurance coverage.

Can You Be Denied Coverage for Pre-Existing Conditions?

It is important to recognize that pre-existing conditions are rather common. More than 82 million Americans have a pre-existing condition. That is a main reason that our government addressed this issue with the Affordable Care Act. Due to that legislation, insurance companies in the United States cannot deny coverage based on these factors. It is also illegal for insurance companies to inflate costs based on pre-existing conditions. Obviously, this is a significant protection for the many Americans who are purchasing new coverage while managing a disease.

What Does This Mean?

Having pre-existing conditions was a liability in the past. These legal protections prevent unfair treatment of the consumers. And these situations could arise frequently. For example, if you are aging out of your parents’ health insurance or starting a new job, you could be vulnerable. It could also be an issue if you are pregnant and your spouse, who is the policyholder, starts a new job. Now, insurance companies are legally prevented from charging you more because of any pre-existing condition. They cannot deny you treatment or medication or limit your coverage. For one thing, this provides security and peace of mind. It also opens up the insurance options for you and your family. You have the ability to switch plans without this fear.

What About a Grandfathered Plan?

First, you need to know if the plan you have today is “grandfathered”. This means that the health insurance policy was acquired before March 23, 2010. The Affordable Care Act does not apply to these policies. They usually do not offer the same customer benefits as a plan under the Affordable Care Act. However, you might be sufficiently covered if the plan was well suited for your health needs.

Of course, there are downsides to these plans. For example, your insurance company could deny you coverage based on conditions you had previously. They could also charge you more based on such pre-existing conditions. These policies do not have to abide by the regulations set on March 23, 2010. Thus, consumers with these plans do not have the protections of the Affordable Care Act. Of course, if you do not have any pre-existing conditions, there is nothing to worry about. You may feel you have the coverage you need at the price that works best.

The Takeaway for Pre-Existing Conditions

The first step is to determine when you secured your policy. Then think about any pre-existing conditions you may have. Next, evaluate your insurance needs and costs. It is always a good idea to get some new quotes and compare what is available. Make insurance companies compete for your business. Use the consumer marketplace to your benefit and get the best coverage for you!

Overall, it is important to remember that health insurance is not one size fits all. Thus, it can be difficult to make a decision about your health coverage. It is always important to do your own research. Knowledge is power. The information on our site will make you well-informed. That is the best way to ensure fair treatment. Use our site to compare health insurance quotes.


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