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  • Writer's pictureAhsan Malyk

Can I Be Denied Health Insurance Because Of A Pre-Existing Condition?

Any illness or injury you had before you started your new health insurance plan can be considered a pre-existing medical condition. Illnesses such as diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea are examples of existing health problems. They tend to be chronic or long-term.

How are existing states identified?

A pre-existing condition usually exists if it was treated or diagnosed before you enrolled in new health insurance. Before the Affordable Care Act (ACA) was passed in 2010, insurers reviewed applications and denied coverage or offered coverage at a premium if they determined there was a pre-existing medical condition. I was doing

The ACA made it illegal for health insurers to deny care or increase rates based on pre-existing conditions.

What are some examples of pre-existing conditions?

Chronic diseases and conditions, including many forms of cancer, diabetes, lupus, epilepsy, and depression, can be considered pre-existing conditions. Pregnancies prior to enrollment are also considered pre-existing chronic pregnancies. Other less serious conditions such as acne, asthma, anxiety, and sleep apnea, may also be considered.

Can I be denied health insurance if I have a pre-existing medical condition?

If you've been in a plan since 2010, your insurance company can't deny coverage or charge a higher premium because you have a pre-existing condition.

The Affordable Care Act, passed in 2010, made it illegal for insurance companies to deny coverage or charge high premiums for pre-existing conditions. If your medical condition changes while you have health insurance and you develop a chronic illness, the insurance company cannot increase your premium because of that condition. However, an annual premium increase may apply to your plan for other reasons.

However, if you're enrolled in a plan that started before 2010, it's a Grandfathered plan. These plans may cancel coverage or charge higher rates due to pre-existing medical conditions.

When evaluating coverage options, it is important to be aware of changes in healthcare legislation that may affect coverage for existing medical conditions.

Is pregnancy considered an existing condition?

If you become pregnant before enrolling in health insurance, we will not deny premium payments or charge additional fees because of your pregnancy. Pregnancy and childbirth coverage begins on the day you enrol.

Do you have health insurance for pre-existing conditions?

Health insurance choices are no longer based on existing concepts of medical conditions. Health insurance companies cannot deny coverage or increase rates if you have a medical condition when you enrol. However, some health insurance may be more suitable than others if you have a chronic illness or pre-existing medical condition.

For example, if you need regular medical care, surgery, or treatment, a plan with a slightly higher monthly premium and a lower deductible will give you the coverage you need and help you manage costs more predictably.

Does my health plan have a waiting period for pre-existing conditions?

There is no waiting time for health insurance, even if you have a pre-existing number.

Consider your medical needs when choosing health insurance. If you have chronic or ongoing medical conditions that require more frequent care, those needs may influence the type of plan you choose, but you may be denied coverage due to pre-existing medical conditions, or You will never be charged more.

How the Pre-existing Condition Exclusion Period Works

A pre-existing condition exclusion period limits the number of benefits that an insurer has to provide for specific medical conditions and does not apply to medical benefits afforded by a health insurance policy for other types of care.

For example, a policyholder may be excluded from receiving benefits for a pre-existing heart condition for months after starting a policy but may still receive care for conditions that don't qualify as pre-existing, such as the flu.

All Health Insurance Marketplace plans must cover treatment for pre-existing medical conditions. Medicare also typically covers pre-existing conditions without lengthy waitlists.

Conditions for Exclusion

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires insurers to provide coverage to individuals in group health plans and places restrictions on how insurers can restrict some benefits.

Prior to HIPAA, workers with chronic health problems or ongoing treatments and medication often felt forced to stay in their current jobs because a new employer's health plan could impose a long wait for coverage or refuse to cover any cost for the condition at all. The act set guidelines on how and when insurers could exclude health coverage from individuals who had pre-existing conditions before joining the policy.

HIPAA did allow insurers to refuse to cover pre-existing medical conditions for up to the first 12 months after enrollment or 18 months in the case of late enrollment. The existing state cutoff period is a regulated policy feature. In other words, insurers may cap the period over which the cut-off period applies.

Shorter exclusion period for pre-existing conditions

Individuals can reduce the existing state cut-off period by demonstrating that they had eligible coverage prior to joining the new plan. Proof of continued coverage from a previous insurance company is usually required, which may provide other evidence.

Insurers must be notified in writing of any pre-existing medical conditions, and the countdown to the cut-off period will begin immediately after the scheduled required waiting period. In some states, insurers may impose additional restrictions on whether a pre-existing state can include a cutoff period.

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