top of page
  • Writer's pictureAhsan Malyk

Does Employer Health Insurance Cover Pre Existing Conditions?

Many things affect health insurance premiums, and pre-existing conditions can significantly negatively impact your premiums.

Unfortunately, if you have a pre-existing medical condition, you must consider that your premium will be significantly higher. The high premiums are because chronic conditions can be very expensive and may eventually require expensive procedures or surgeries.

What are pre-existing conditions?

About 25% of adults under the age of 65 have a pre-existing medical condition, according to a 2019 study released by the Kaiser Family Foundation. As stated by the Patient Advocacy Foundation, a pre-existing condition is a medical condition, illness or injury you knew about before applying for health insurance.

Some examples of existing states are

  • pregnancy

  • epilepsy

  • asthma

  • sleep apnea

  • cancer,

  • diabetes

Of course, existing medical conditions are not limited to these few examples. You should also be sure to read the details of any plan you are considering to make sure it covers your medical condition or health concerns.

In the past, insurance companies have sometimes charged more or denied people with pre-existing medical conditions. This is because more health problems create a higher-risk member pool. That means insurance companies will pay more to people who are actually getting the most out of their individual health insurance.

Pregnancy as a pre-existing condition

In some cases, there is confusion about whether the pregnancy is pre-existing. Pregnancy is an existing condition that is not treated like any other disease. If you become pregnant before you enroll in insurance, your premium will not increase.

Can I get health insurance if I have a pre-existing condition?

You can enroll in health insurance if you or your family have a chronic disease. However, before the Affordable Care Act (ACA), it was nearly impossible for individuals with pre-existing medical conditions to obtain health insurance. This was not always the case.

Before the passage of the Affordable Care Act (also known as "ACA" and Obamacare) in 2010, insurance companies denied coverage for pre-existing medical conditions or covered people with pre-existing medical conditions and health insurance coverage. This could result in significantly higher insurance premiums. of people with a history of refusal.

This was because insurers paid astronomical amounts for medical care for people with pre-existing conditions. Because they didn't have to include every applicant, insurers began to determine which pre-existing conditions were not covered. Pre-existing medical conditions were sometimes an insurmountable barrier to changing jobs, changing health insurance plans, and finding affordable care.

But that is essentially a matter of the past. The Affordable Care Act was passed to provide people with access to affordable health care and protect those with pre-existing medical conditions. It is no longer possible to refuse compensation for these individuals.

If you're wondering if insurance companies can charge more for pre-existing medical conditions, the answer is no. which family members need coverage, and which specific plan do you choose) can affect the price.

Will a previous illness increase my premium?

Under current law, insurance companies cannot ask for premium increases or deny health insurance coverage because of previous illness. When you purchase an ACA-compliant personal health insurance plan, you don't have to worry about losing health insurance because of a medical condition for you or a family member.

However, to ensure that you choose the health insurance that best suits your and your family's needs, you need to compare health insurance costs and coverage.

A licensed eHealth insurance agent can help you understand your health insurance options and identify plans that are likely to bring you the affordable care you and your family need.

Medicaid or CHIP insurance for pre-existing conditions?

ACA also made it impossible for Medicaid and his CHIP program to deny coverage to anyone with a pre-existing condition.

Therefore, as long as you qualify for these programs, you will be covered for chronic illness from day one. Plans purchased through the Marketplace offer the best health coverage for your existing condition, and if your income is low enough, Medicaid and CHIP do the same.

What's really impacting healthcare costs? When considering getting the best existing health insurance plan, factors other than pre-existing conditions can affect your medical costs.

This may include, for example, family size, whether you use tobacco, and which insurance plan you end up on. Also, not all health insurance companies offer coverage for pre-existing conditions. Healthcare can be nearly out of reach if you don't choose a plan from the marketplace and already have a medical condition.

Is there a waiting period for health insurance coverage if I have a pre-existing condition?

Depending on the specific medical plan you end up purchasing, there may be a waiting period before pre-existing conditions are covered.This period can be 12 to 18 months. This means that if you receive treatment for your illness before this period ends, you will have to pay for it out of your own pocket. Contact your health insurance company for plan details.

Be aware of these types of health insurance plans if you have pre-existing medical conditions

If you or a family member have a pre-existing condition, you should be aware of two main exceptions that your health insurance company may not cover for pre-existing conditions.

Short term medical guidelines: Short-term health insurance is excluded from statutory insurance coverage for pre-existing conditions. Even short-term health insurance companies that accept your application may set a waiting period before covering treatment for pre-existing conditions.

It can be renewed annually: Because the coverage period is relatively short, short-term insurance may not help pay for existing medical expenses, even if the insurance company accepts the claim.

Grandfather Group Health Plan: If you or a family member with a pre-existing medical condition is eligible to insure yourself or a family member with health insurance from your employer or union group, check with your plan administrator first. to determine if the plan is “not applicable”. Excluded plans are health plans that existed prior to March 23, 2010. By law, these health plans can provide the same benefits today as they did before the Affordable Care Act. You can limit or exclude insurance coverage for existing conditions.

How can I get health insurance if I have a pre-existing medical condition?

If you have a pre-existing medical condition, it's important to take your time when switching insurance companies with your existing condition and find the best health insurance plan for you. If you can't find the best health insurance for your existing condition, you could be denied coverage for that condition and end up paying large out-of-pocket costs.

Finding health insurance in your existing state is easy. ACA-compliant health insurance is available in and out of your state's market. eHealth can help you find the plan that's right for you. Check out all the individual and family health insurance plans available in your area and start your search today. Simply answer a few questions about your health insurance needs and select Find an ACA Plan.

The eHealth Plan Finder tool identifies plans available in your area and allows you to compare costs and benefits. Our health insurance brokers and agents are also on your side to provide help and advice. eHealth's goal is to help you find affordable and effective health insurance regardless of your current health status.

1 view0 comments


Post: Blog2_Post
bottom of page