Can I get coverage if I have a pre-existing condition? (2024)

FAQs

Can I get coverage if I have a pre-existing condition? ›

The impact of pre-existing conditions on health insurance is significant, particularly in how these conditions affect eligibility and premium costs. Firstly, thanks to the Affordable Care Act (ACA), insurers can no longer deny coverage or charge higher premiums based solely on pre-existing conditions.

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.

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.

Due to the added risk health problems create for insurers, some pre-existing conditions can raise your premium or even disqualify you entirely from certain types of life insurance. A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma.

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.

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.

What are pre-existing medical conditions? 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.

Post-claims underwriting can also be used by these non-ACA-compliant plans, meaning that they'll accept most applicants with little in the way of upfront underwriting, but will then do a thorough check of the person's medical history if and when they have a medical claim; if the condition is determined to be pre- ...

Existing is a certain thing that is present nowadays and can be seen in present time. Preexisting refers to something that has existed a long time ago, and forgotten, and has existed once more in our present time.

In the health insurance world, a pre-existing condition is any injury, sickness or condition that exists before the date an insurance policy takes effect. Examples include asthma, diabetes, anxiety, depression, high blood pressure, high cholesterol and so on.

What are 3 reasons you may be denied from having life insurance? ›

They can include engaging in risky hobbies and behaviors like skydiving; having a history of DUIs or speeding tickets; having a dangerous job like roofing; having a criminal record or a less than ideal financial history; being a smoker; and failing a drug test.

As long as you were truthful on your application and kept up with payments, your life insurance policy provider can't revoke coverage because you've experienced a change in your health.

Their reasons could be anything from a serious medical condition (like heart disease) or poor results from your life insurance medical exam to nonmedical reasons like bankruptcy, a criminal record, a positive drug test or even a dangerous hobby—carriers are not fans of insuring base jumpers in squirrel suits.

If your health plan is fully compliant with the ACA and obtained in either the individual/family market or the employer-sponsored market, you no longer need to worry about pre-existing condition exclusion periods.

If the denial reason was “no pre-authorization,” ask the plan to back-date one. If they will, resubmit the claim with a note including the new auth number. If they won't, appeal.

A 12/12 pre-existing condition means that if you have a claim in the first twelve months, the insurance company will look back 12 months before you started the policy to see if you had a pre-existing condition that might have caused it.

Today, insurers cannot deny coverage to somebody based on pre-existing conditions, nor charge more. A pre-existing condition is any health problem or ailment that was previously diagnosed at the time of applying for coverage.

Insurance companies are no longer able to deny coverage, charge more, impose waiting periods, or deny treatment for anyone with pre-existing conditions. The only exceptions are procedures like cosmetic surgery that aren't considered medically necessary.

In some cases, the Medigap insurance company can refuse to cover your out of pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition.