How to get health insurance with pre-existing conditions in 2019 and 2020

Insurance companies can no longer deny you coverage based on health problems.

Elissa

Elissa Suh

Published October 9, 2019

KEY TAKEAWAYS

  • Pre-existing conditions are protected under the Affordable Care Act

  • Insurers cannot deny health coverage for people for pre-existing conditions

  • Insurers cannot charge higher costs for people with pre-existing conditions

  • Insurers cannot subject people with pre-existing conditions to a waiting period

Pre-existing conditions are medical conditions and health problems that occurred before the start date of your health insurance coverage. Examples of pre-existing conditions include cancer, asthma, diabetes or even being pregnant.

Under the Affordable Care Act (Obamacare), health insurance companies cannot refuse to cover you because of any pre-existing conditions nor can they charge you for more money for the coverage or subject you to a waiting period. This went into effect for plans that begin on and after January 1, 2014.

In this article:

What is considered a pre-existing condition?

Any health problems that you have prior to getting an insurance plan qualifies as a pre-existing condition. Health insurance companies decide what is considered a pre-existing condition. In theory, it could be any condition that might be costly for the health provider to cover.

According to the Kaiser Family Foundation, common examples of pre-existing conditions that affected coverage before the ACA are:

  • AIDS/HIV
  • Cancer
  • Cerebral palsy
  • Depression and other mental health disorders
  • Dementia (Alzheimer’s)
  • Diabetes
  • Epilepsy
  • Gender dysphoria
  • Heart disease, coronary artery, bypass surgery
  • Hemophilia
  • Hepatitis C
  • Lupus
  • Obesity
  • Paraplegia
  • Paralysis
  • Pregnancy
  • Pending surgery or hospitalization
  • Sleep apnea
  • Stroke

Even a more minor medical condition — like acne, tonsillitis, high blood pressure or menstrual irregularities — could be deemed a health issue, depending on the provider.

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Are pre-existing conditions still covered?

Insurance companies cannot deny you health coverage based on a pre-existing condition. It is also illegal for them to charge more money for your plan because of the pre-existing issue or refuse to cover the 10 essential health benefits that must be included in every insurance policy.

Passed in 2010, the Affordable Care Act helps make health insurance more affordable for Americans. Guaranteed coverage of pre-existing conditions applies to all health plans that people enrolled in beginning on or after January 1, 2014.

Before the Affordable Care Act

Prior to Obamacare, insurance companies could reject people for any number of pre-existing health conditions – including something minor as mentioned before – or increase the costs of their coverage. People had to enroll in a pre-existing condition insurance plan (PCIP) — a health program specifically designed for individuals who had been rejected on the basis of a medical condition. PCIP coverage ended in 2014 when the Obamacare protections went into effect.

When you can be denied for pre-existing conditions

Health insurance plans that started on or before March 23, 2010 – called grandfathered plans — are not subject to the rules of Obamacare. That means if you enrolled in a health plan prior to this date, your insurer can choose to cancel your policy or increase your premiums for pre-existing medical conditions.

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