Can you qualify for health insurance? Pre-existing medical conditions are loosely defined as medical conditions for which you received treatment before the start date of your health insurance. For example, if you had asthma as a child, and then as an adult you apply for health insurance, the insurer may refuse to cover you for asthma because that condition started before your application for the policy.
“A pre-existing condition is a risk with extant causes that is not readily compensated by standard, affordable insurance premiums. Pre-existing condition exclusions by the insurance industry are meant to cope with adverse selection by potential customers. Such exclusions have become a topic in the health care reform debate in the United States in 2009 and 2010. Several surveys over that period have shown a very strong opposition to the exclusions and support for banning them.”
Having pre-existing conditions does not mean that your application will be denied, but it does affect the completeness of your coverage. Sometimes insurance companies place waiting periods on a policy for pre-existing conditions or for certain kinds of conditions. A waiting period for coverage means that once your policy starts, you must wait six months (or whatever period the company specifies) before those conditions will be covered.
Ten Common Pre-existing Conditions as reported by healthreform.gov and medhealthinsurance.com:
- Diabetes
- Asthma
- Arthritis
- Cancer
- Hay Fever
- High Blood Pressure
- Depression
- Obesity
- Fibromyalgia
- Heart Disease
The issue of pre-existing conditions is controversial because it basically gives the insurance company the right not to pay for your health care if it can associate a pre-existing condition with your current medical claims. When you are buying a policy, it is important to carefully read the parts that explain its coverage and payment for pre-existing conditions. It is also a good idea to check with your State Department of Insurance for information on the reliability of the company when it comes to paying expenses. In some cases, insurance companies may agree to cover some of your earlier medical conditions but charge you higher premiums and cost sharing (deductibles, co-payments, and co-insurance).
Healthreform.gov offers insight into current insurance industry practices granting and denying coverage where prior conditions are involved. Healthreform.gov reports:
“Insurance discrimination based on pre-existing conditions makes adequate health insurance unavailable to millions of Americans.
In 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market. Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition.
A recent national survey estimated that 12.6 million non-elderly adults 5 – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years.
In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.”
Although the Obama administration changes to health care laws may require insurance companies to cover you for all pre-existing conditions, that will not go into effect universally until 2014. Also, starting in September 2010, the Patient Protection and Affordable Care Act required insurance companies to cover children under the age of 19 on their parents’ policy for pre-existing conditions. However, at present time, insurance companies can still refuse to cover adults if the health profile is deemed too risky.
Healthcare.gov offers a wealth of statistics and facts regarding pre-existing conditions. Specifically, it goes on to say:
“According to a new analysis by the Department of Health and Human Services, 50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition. Up to one in five non-elderly Americans with a pre-existing condition – 25 million individuals – is uninsured. Under the Affordable Care Act, starting in 2014, these Americans cannot be denied coverage, be charged significantly higher premiums, be subjected to an extended waiting period, or have their benefits curtailed by insurance companies.”
For more detailed information, click here to download our free, no-obligation report on pre-existing conditions and health care risk.
However, in some cases, where you have conditions that demonstrate improvement with treatment, such as with high blood pressure, weight, and cholesterol, if you can show improvement, the company may agree to cover you or may lower your premium rates if you demonstrate positive changes in those conditions.
One other point to note is that employer sponsored health insurance plans must cover you and dependents listed on the policy for pre-existing medical conditions. In cases where you have employment that includes group health insurance, when your employment terminates you are guaranteed continuation of coverage under COBRA, which stands for Consolidated Budget Reconciation Act of 1985. This basically guarantees you coverage for 18 months after termination, though in some cases it may be longer. For more information you check the Department of Labor site at http://www.dol.gov/dol/topic/health-plans/cobra.htm.
Find more information on COBRA alternatives to see if they might serve your needs for a lower cost.
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