Home > FAQ > Can I Be Denied Health Insurance for a Preexisting Condition?
Under federal law, a health insurance company cannot refuse to cover you or charge you more based on a pre-existing condition. A “pre-existing condition” is a health problem you had before the date your new coverage starts.
The Affordable Care Act Prevents Denial for Pre-Existing Conditions
Historically, health insurance providers limited coverage for people with significant pre-existing conditions. If someone was unlucky enough to be diagnosed with diabetes, cancer, or a debilitating knee or back injury, health insurance companies were likely to either exclude coverage for treatments of those ailments in the plan, charge policyholders significantly more for their policies, or deny health insurance entirely.
Thanks to the Patient Protection and Affordable Care Act, also called the Affordable Care Act (ACA) or “Obamacare,” health insurance companies are no longer allowed to deny health insurance coverage based on pre-existing conditions. President Obama signed the ACA into law on March 23, 2010. Among the ACA’s massive overhauls included the establishment of a marketplace for consumers to purchase health insurance, and restrictions on the limitations insurance companies were allowed to put in policies.
According to current law, all marketplace policies must cover treatment for pre-existing medical conditions. More specifically:
- No insurance plan can reject you based on conditions you had before your coverage started.
- Insurance companies cannot charge you more or subject you to waiting periods based on pre-existing conditions.
- Insurers cannot refuse to pay for essential health benefits for any pre-existing conditions.
- Additionally, once you are enrolled, the plan cannot deny you coverage or raise your rates based solely on your health.
What Are Pre-Existing Conditions?
Pre-existing conditions are health problems you had before getting your insurance plan. They can range from physical injuries to illnesses to psychological disorders. Theoretically, they could include any condition that an insurance company might have to pay a healthcare provider to treat.
Common pre-existing conditions that used to affect coverage before the ACA include:
- Cancer
- Diabetes
- HIV/AIDS
- Cerebral Palsy
- Epilepsy
- Gender dysphoria
- Hemophilia
- Obesity
- Paraplegia
- Paralysis
- Hepatitis C
- Depression
If you are denied health insurance coverage based on a pre-existing condition, the insurance company is acting in violation of federal law. Talk to an insurance law attorney about your options for coverage and compensation.
Certain “Grandfathered” Plans Can Deny Coverage for Pre-Existing Conditions
Policies in effect before the Affordable Care Act went into effect are not subject to the same limitations. If you have an individual health insurance plan (the kind you purchase yourself, as opposed to the kind you get through your employer) that you purchased on or before March 23, 2010, then your plan is not controlled by all of the ACA protections. Those plans do not need to provide coverage for pre-existing conditions. If, for example, you already had a diagnosis for cancer when you purchased your individual plan in 2009, your insurer might not need to provide coverage for your cancer treatments now.
Get the Coverage You Are Owed With Help From Gianelli & Morris
If you are wrongfully denied insurance coverage, if your California insurance has been wrongly rejected, or if you have experienced bad faith conduct by an insurance company, call the insurance law attorneys Gianelli & Morris for a free consultation regarding your case.
FAQs
No insurance plan can reject you based on conditions you had before your coverage started. Insurance companies cannot charge you more or subject you to waiting periods based on pre-existing conditions.
Can I be denied health insurance because of a pre-existing condition? ›
Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can't charge women more than men.
Why can't pre-existing claims be denied? ›
The Affordable Care Act, passed in 2010, made it illegal for insurers to deny you coverage or charge high rates for pre-existing conditions.
What is the exclusion period for pre-existing conditions? ›
The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.
Can people with preexisting conditions worry less about health insurance coverage due to the Affordable Care Act? ›
Firstly, thanks to the Affordable Care Act (ACA), insurers can no longer deny coverage or charge higher premiums based solely on pre-existing conditions. This has dramatically increased access to health insurance for individuals with chronic health issues.
Is it hard to get insurance with a pre-existing condition? ›
Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.
Can Unitedhealthcare deny coverage for preexisting conditions? ›
You cannot be denied coverage based on preexisting conditions.
What counts as a pre-existing medical condition? ›
A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.
What qualifies as a pre-existing condition? ›
A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.
Can an insurer exclude coverage for a pre-existing condition? ›
A pre-existing condition is any health problem, like diabetes, or cancer, that you had before the date you applied for insurance. Insurers cannot refuse to cover treatment for your pre-existing condition or charge you more under the ACA.
A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.
What is the 12 month waiting period for pre-existing conditions? ›
12-months Condition Specific Waiting Period – this is a period during which a member is not entitled to claim benefits in respect of a condition for which medical ad- vice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which an application for membership was ...
What is a waiver of pre-existing conditions? ›
Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy. It's a feature only available with certain comprehensive package plans that include trip cancellation/trip interruption.
What are 3 reasons that a person might not have health insurance coverage? ›
One's chances of being uninsured increase if one works in an occupation or in an employment sector where employers are less likely to offer a health benefit, if one is self-employed or works for a small private-sector firm, or if one has too low an income to afford coverage.
Does Obamacare cover all pre-existing conditions? ›
All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
Is obesity a pre-existing condition? ›
Declinable Pre-existing Conditions
Declinable conditions included AIDS/HIV, congestive heart failure, diabetes, epilepsy, severe obesity, pregnancy, and severe mental disorders.
Can you get life insurance if you have a pre-existing illness? ›
Pre-existing conditions can make it more difficult and expensive to get life insurance, but even if you have a chronic or terminal health problem, you can likely find a policy you qualify for if you shop around.
When were pre-existing conditions eliminated? ›
Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.
What is the difference between acute onset of pre-existing conditions and pre-existing conditions? ›
Pre-existing conditions are the medical issues themselves, while the acute onset of pre-existing conditions is the sudden and unexpected recurrence of a pre-existing condition.
