What Does "Pre-Existing Conditions" Mean for My Health Insurance?

The Kaiser Family Foundation reports that pre-existing conditions affect more than 25% of people under the age of 65. These could be anything as simple as asthma or high blood pressure or something more serious like diabetes or cancer. People with pre-existing diseases were frequently refused coverage or charged more by insurers in the individual insurance market prior to the passage of the health reform law. After the Affordable Care Act was passed in 2014, that technique was declared illegal.

A Pre-Existing Condition: What Is It?

Any disease, injury, or medical concern that existed prior to the start of your health insurance coverage is referred to as a pre-existing condition. "Any sickness or disease for which a physician has given advice, diagnosis, care or treatment, or for which symptoms have been present, within the six months preceding your enrollment in a new health insurance policy" is what the state of Maine defines as a pre-existing condition. Health insurers are prohibited by the Affordable Care Act from refusing coverage to those who have specific conditions that are deemed pre-existing. These include long-term chronic illnesses like high blood pressure, arthritis, and back problems, as well as diseases like diabetes, cancer, and asthma. 54 million non-elderly people, according to the Kaiser Family Foundation, had a medical condition that would have prevented them from being covered by private health insurance in the individual market prior to the Affordable Care Act. These people are now protected by the Affordable Care Act (ACA) and have access to a range of plans to suit their needs.

A Pre-Existing Condition Exclusion Period: What Is It?

Pre-existing condition exclusion periods were widespread in the individual health insurance market prior to the Affordable Care Act. Any medical care for a condition that existed prior to the person enrolling in their new health plan would be covered by those exclusions. Health insurers are prohibited by the Affordable Care Act from refusing to cover you or raising your premiums due to any health issues you may have. However, if a new enrollee has less than 18 months of creditable coverage, health insurers may still impose a pre-existing condition exclusion period. Any sickness, injury, or handicap for which you sought medical advice, care, or treatment within the six months that ended on the date of your initial enrollment in a health insurance policy is considered a pre-existing condition. Pregnancy cannot be excluded from coverage due to a pre-existing condition, but maternity coverage might. Genetic information is not considered a pre-existing condition. Furthermore, subscribers to Medicare Advantage plans are not permitted to be excluded from coverage due to pre-existing conditions.

What is the waiting period for a pre-existing condition?

Prior to the implementation of the Affordable Care Act, popularly referred to as Obamacare, pre-existing conditions posed a significant challenge in the individual market when insurance was purchased on one's own rather than via employment. In the past, pre-existing conditions might have resulted in insurance companies refusing to cover them or charging exorbitant fees. There are no longer any waiting periods for pre-existing conditions under the Affordable Care Act (ACA), and all marketplace individual plans are required to cover them all at no additional cost. Grandfathered individual market plans and employer-sponsored group health insurance plans that were acquired before March 23, 2010, and have not been changed to meet the standards of the Affordable Care Act (ACA) are exempt. Many people who were previously unable to get insurance are now able to do so. However, in order to ensure that you don't miss out on the chance to buy your plan, it's critical to be aware of the dates on which you will qualify for a special enrollment period.

What is the waiting period for a post-existing condition?

Prior to the enactment of the Affordable Care Act (ACA), health insurance providers frequently had the option to refuse coverage for pre-existing diseases or to charge much higher premiums. Those times were a long time ago. It's crucial to realize that there are still situations in which pre-existing condition exclusion periods apply. For instance, you can be subject to a 12-month pre-existing condition exclusion period if you have an individual policy that you bought on your own rather than through your employer and the pre-existing condition was treated within the six months prior to the commencement of your new plan. The pre-existing condition exclusion period for Medicare supplements varies by plan and insurer; therefore, this is similar to how Medigap policies operate. These restrictions are typically less stringent than those associated with conventional health insurance plans, though. Additionally, this limit may be lifted in some cases if you can demonstrate that you had creditable coverage during the period your new policy was in effect. This is applicable to certain non-ACA individual policies as well as individual health insurance that complies with the ACA.