What is a Pre-Existing Condition? (2024)

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

If you are enrolled in a plan since 2010, then your insurer can’t legally deny you coverage or charge you higher premiums because you have a pre-existing condition.

The Affordable Care Act, passed in 2010, made it illegal for insurers to deny you coverage or charge high rates for pre-existing conditions. Additionally, if your health changes and you develop a chronic medical condition while enrolled in a health plan, your insurance carrier cannot raise your rates because of that medical condition. However, annual premium increases may apply to your plan for other reasons.

If, however, you are enrolled in a plan that started before 2010, you have a “grandfathered plan”. These plans can cancel your coverage or can charge you higher rates due to a pre-existing condition.

If you are exploring coverage options, it’s important to be aware of any potential changes to health care law that could impact how pre-existing conditions are covered.

Is pregnancy considered a pre-existing condition?

If you get pregnant before enrolling in a health plan, you cannot be denied coverage or charged more due to pregnancy. Coverage for pregnancy and delivery begins from the day you enroll in a plan.

Is there health insurance for pre-existing conditions?

Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment. However, there may be health plans that are a better fit for you than others if you have a chronic, or pre-existing, medical condition.

For example, if you need regular medical care, surgeries, or treatments, then a plan with a little higher monthly premium and lower deductible may provide you with the coverage you need and help you manage more predictable costs.

Could my health plan have a pre-existing condition waiting period?

No. There are no waiting periods for medical plans, including for pre-existing conditions.

When choosing a health plan, consider your medical needs. If you have a chronic or ongoing medical condition that requires more frequent care, those needs could affect the type of plan you choose, but you cannot be denied coverage or charged more due to a pre-existing condition.

What is a Pre-Existing Condition? (2024)
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