Many things affect your health insurance premium and a pre-existing condition can significantly affect it in a negative way.
Unfortunately, you can expect to pay a much higher premium if you have a pre-existing condition. The reason your premiums will be higher is that your chronic condition is expected to become very expensive and may even require expensive procedures or surgery at some point.
what is a pre-existing condition?
approximately 25% of adults under the age of 65 have pre-existing conditions, according to a 2019 study published by the kaiser family foundation. As the Patient Advocacy Foundation points out, a pre-existing condition is a medical condition, illness, or injury that you know about (perhaps even received or have treatment scheduled) before you apply for health insurance coverage.
Some examples of pre-existing conditions include:
- sleep apnea
Pre-existing conditions, of course, are not limited to these few examples, and you should be sure to read the details of any plan you are considering to ensure that your plan covers any medical condition or health issue you have. .
Insurance companies used to sometimes charge more or turn down people with pre-existing conditions. This is because more health problems will result in a high-risk pool of members, meaning the insurance company was doling out more money to people who actually used their individual health insurance the most.
pregnancy as a pre-existing condition
In some cases, people may be confused about whether the pregnancy is a pre-existing condition. pregnancy is a preexisting condition, but it is not treated in the same way as other diseases. Your insurance premium will not increase, nor will you be denied maternity coverage if you become pregnant before seeking insurance.
Can I get health insurance with a pre-existing condition?
You can get health insurance if you or a family member has a pre-existing condition. However, prior to the implementation of the Affordable Care Act (ACA), it was almost impossible for people to obtain health insurance with pre-existing conditions. this has not always been the case.
Before the passage of the Affordable Care Act in 2010 (also known as “aca” and obamacare), insurance companies could decline coverage for pre-existing conditions, charge significantly higher premiums to insure people with pre-existing conditions. conditions, or deny applications for health insurance from people with pre-existing conditions. this was because insurance companies were paying astronomical amounts for medical care for people with pre-existing conditions, and since they were not required to accept all applicants, they began to determine which pre-existing conditions were not covered. preexisting conditions posed sometimes insurmountable barriers to changing jobs, changing health insurance, and finding affordable care. but that’s largely a problem of the past.
Not only was the Affordable Care Act passed to give people access to affordable health care coverage, it was also passed to protect people with pre-existing conditions. these people can no longer be denied coverage, and if you’re wondering if an insurer can charge more for pre-existing conditions, then the answer is “no,” even though other conditions (for example, age, where you live, how many people in your family require coverage, which specific plan you choose), may affect your rates.
Will a pre-existing condition result in a higher premium?
Under current law, insurance companies cannot charge higher premiums or deny health insurance coverage because of pre-existing conditions. If you’re shopping for an ACA-compliant individual health insurance plan, you won’t have to worry about health insurance being out of reach because of pre-existing conditions you or a family member may have. however, you should still compare the costs and coverage of health insurance plans to make sure you are choosing the health plan coverage that best suits you and your family’s needs.
A licensed eHealth Insurance Agent is available to help you understand your health insurance options and identify plans that are likely to result in the affordable care you and your family need.
can i get medicaid and chip coverage with pre-existing conditions?
the aca has also made it impossible for medicaid and chip programs to deny coverage to people with pre-existing conditions.
As a result, as long as you qualify for these programs, you can receive coverage for your chronic conditions from day one. Plans purchased through the Marketplace offer the best health insurance for pre-existing conditions, and if your income is low enough, Medicaid and CHIP are low enough, too.
what really affects my health care costs?
When considering buying the best health insurance for pre-existing conditions, there are other factors that can affect your health care costs besides pre-existing conditions.
For example, this may include the size of your family, whether or not you use tobacco, and what insurance plan you end up purchasing. Also, not all health insurance plans offer coverage for pre-existing conditions. If you don’t choose a plan through the Marketplace and you have a pre-existing condition, your health care could end up almost impossible to pay for. another option for
Is there a waiting period for health insurance coverage to apply for pre-existing conditions?
Depending on the specific medical plan you end up purchasing, there could be a waiting period before pre-existing conditions are covered. this period can be from 12 to 18 months, which means that if you receive treatment for your condition before this period has elapsed, you may have to pay out-of-pocket costs. To understand the details of your plan, contact your health insurance provider.
beware of these types of health insurance plans if you have pre-existing conditions
If you or a family member has a pre-existing condition, you should be aware of the two main exceptions in which health insurers may not cover pre-existing conditions.
- short-term medical policies. short-term medical policies are exempt from the law that requires insurance coverage for pre-existing conditions. even short-term health insurers that accept your application may impose a waiting period before covering treatment related to a pre-existing condition. a short-term medical policy can be valid for 90 to 364 days and can be renewed for up to three (3) years. Given its relatively short duration, a short-term policy may not help you pay for treatment of pre-existing conditions, even if the insurer accepted your request.
- protected group health plans. If you can get coverage for yourself or a family member with a pre-existing condition under employer or union group health coverage, be sure to check first with the plan administrator to see if the plan is grandfathered. Protected plans are health plans that were in effect before March 23, 2010. By law, these health plans can offer the same benefits they offered today before the Affordable Care Act. may restrict or exclude coverage for pre-existing conditions.
How can I get health insurance with a pre-existing condition?
If you have a pre-existing condition, it’s important to take your time when switching insurance with a pre-existing condition to find the best health insurance. If you are unable to find the best health insurance plan for your pre-existing condition, then you could end up being denied coverage for your condition and having to pay substantial amounts out of pocket.
It’s easy to find health insurance with a pre-existing condition. ACA-compliant health insurance is available in your state’s marketplace and outside of the marketplace. let ehealth help you find the plan that’s right for you. You can start your search now by reviewing all available individual and family health insurance plans in your area. simply answer a few questions about your health insurance needs and select find plans here. The electronic health plan search tool will identify plans available where you live and allow you to compare costs and benefits. our health insurance brokers and agents are also available to help you. At ehealth, our goal is to help you find effective health coverage at an affordable price, regardless of your current health condition.