Know Your Rights Regarding Health Insurance and Pre-Existing Conditions

Prior to the passage of the Affordable Care Act, also known as "Obamacare," in 2010, obtaining health insurance presented significant challenges for those with pre-existing medical issues. When Lori looked for coverage in the individual market, she was able to discover policies that either charged her significantly more or excluded her high blood pressure.

A Pre-Existing Condition: What Is It?

An ailment or health issue you had before signing up for new health insurance coverage is known as a pre-existing condition. These ailments or wounds include long-term disorders like diabetes or asthma, short-term problems like a severe injury, and healed ailments like a reconstructed joint. Before the Affordable Care Act, sometimes known as Obamacare, was passed into law, insurance companies had the authority to utilize medical underwriting in almost all states to deny applications, raise premiums, or refuse to cover people with pre-existing medical issues. Finding reasonably priced individual major medical coverage, buying health insurance outside of the workplace, or switching professions were sometimes rendered impossible by these exclusions and inflated costs. 54 million non-elderly people, according to KFF estimates, had a "declinable" pre-existing illness in 2018 that would have made them ineligible for insurance in each major medical market prior to the ACA. These include severe obesity, diabetes, AIDS/HIV, congestive heart failure, and/or a combination of these illnesses. These people probably have Medicare and Medicaid or are enrolled in group plans at work.

Which regulations apply to pre-existing conditions?

Health insurance companies had the right to refuse coverage according to a patient's medical history prior to the implementation of the Affordable Care Act, also known as Obamacare. They might also apply waiting periods or, more frequently, permanently bar your ailment from coverage. In the past, individual market insurers would examine an applicant's medical records spanning one to ten years. The pre-existing ailment would thus either not be covered by the insurance or would cost you a lot more. Pre-existing conditions must be covered by all marketplace health plans under the ACA without discrimination, and you must be able to add any extra coverage that best suits your needs. Prescription medication coverage, dental and eye care, long-term care, and telemedicine services are all included in this. Medicare Advantage plans and some Medigap and short-term health insurance policies are examples of plans that predate the Affordable Care Act (ACA); however, they might still follow distinct regulations.

How Can Someone with a Pre-Existing Condition Obtain Health Insurance?

Prior to the enactment of the Affordable Care Act (ACA, also known as Obamacare), individuals with pre-existing diseases could not obtain coverage from health insurance companies or would have to pay exorbitant costs. Pre-existing conditions are now required to be covered by any health insurance plan that complies with the ACA. Anything that you were sick or injured from before you applied for a new health insurance plan is considered a pre-existing condition. It may be as simple as asthma or seasonal allergies, or it could be as serious as type 2 diabetes or cancer. Pre-existing conditions can also include cured conditions like a broken limb or persistent ailments like heart disease or recurrent infections. Before the health insurance company will start paying for a certain plan, certain pre-existing conditions may need to wait 12–18 months. If there is a waiting time, it is crucial to ascertain how long it will last for your particular circumstance. When you apply for coverage, all insurance firms are required to provide you with this information.

How Can I Receive Assistance for a Pre-Existing Illness?

Affordable health insurance is significantly hampered by pre-existing conditions. Before the ACA was passed, having a medical condition—such as diabetes, cancer, asthma, or pregnancy—meant that private insurers could refuse to cover you or raise your costs. They might also restrict the benefits you get for these disorders or exclude them from your coverage. Thankfully, the ACA has made this discrimination illegal. People who have pre-existing medical issues can now enroll in government programs like Medicare and Medicaid or receive coverage via major medical plans that comply with the Affordable Care Act. However, you may still be refused coverage or have your premium increased for pre-existing diseases if you have them, especially if you have short-term medical insurance or certain non-ACA-compliant policies in the individual and small group marketplaces. Here's where you can find out if your plan complies with the ACA.