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Health Insurance for Pre-Existing Conditions

Is it possible to obtain health insurance with pre-existing conditions? What is a pre-existing condition exactly? How will a pre-existing medical condition affect the cost of my health insurance plan if I am approved? What are some things to do so that I don’t have to worry about getting in trouble with a possible future pre-existing condition?

Let’s take a look at these different questions and try to clear up an area of health insurance that seems to have a great deal of ambiguity and uncertainty (it is worth noting here that health insurance is regulated at the state level so while these general principles hold true across pretty much all 50 states – some of the specifics may be different from one state to another).

You will definitely want to speak with a health insurance agent that is familiar with your state’s insurance laws. [Use our free health insurance quote finder to search by zip code]). By the end of this article you should be able to have enough information on pre-existing conditions and how they work that you can head in the right direction with your health insurance search.

What Is A Pre-Existing Condition?

What is a pre-existing condition? A pre-existing condition is defined very differently from the group health insurance side to the individual health insurance side. On the group health side a pre-existing condition is anything that you sought treatment for or knew that you had a health issue with in the 6 months prior to joining the group health plan. Most group health insurance plans state that if you did not keep continuous insurance coverage and then join their group health plan that the insurance company can look back 6 months and then not cover anything related to those pre-existing conditions found in the 6 months for 12 months (sometimes 18 months for those who join the plan late).

Group Health Insurance And Pre-Existing Conditions

The way this works practically on the group health side is that this pre-existing condition limitation keeps people that foolishly have no insurance and then incur large medical bills from then deciding to hop on a group health plan (group health plans accept employees automatically – this is why a group health insurance plan is approximately 2-3 times the cost of a comparable individual health insurance plan) and then expect the insurance company to immediately start paying all of their large medical bills. Naturally, everyone that is sick or has medical bills will want health insurance but only a responsible individual will do the right thing and purchase adequate health insurance before they actually might need it.

Individual Health Insurance And Pre-Existing Conditions

On the individual health insurance side a pre-existing condition is defined very differently. Again, keep in mind that this can vary from company to company and from state to state but with most insurance companies (meaning big reputable companies with comprehensive major medical plans and standard underwriting departments – think Blue Cross and Blue Shield, United Healthcare, Aetna, and others like them – no indemnity policies with very low coverage limits) their underwriting guidelines will not have a large degree of variance from the norm. That being said, a pre-existing condition is defined in individual health insurance as any type of medical issue in the last 10 years.

Major Vs. Minor Pre-Existing Conditions

Insurance companies will further segregate pre-existing conditions into 2 main categories: major and minor. Major pre-existing conditions will be things like heart disease, cancer, diabetes, etc. while minor pre-existing conditions will be things like high blood pressure, high cholesterol, mild asthma, etc.

Major pre-existing conditions will cause an individual health insurance application to be declined UNLESS the applicant is eligible for a federally mandated plan that is guaranteed issue – a HIPAA health insurance plan. With a HIPPA plan all pre-existing conditions will be covered and the insurance company cannot refuse coverage.

Minor pre-existing conditions can be handled one of two ways on the individual health insurance side depending on the health insurance company: rate up or rider. Rate up means that the insurance company will increase your monthly rate in order to cover all of your minor pre-existing conditions – this method is not as common as ridering. Ridering means that the insurance company will place a rider on the policy excluding coverage for the minor pre-existing conditions either for a set period of time (12 months, 24 months, etc.) or for an indefinite time period. The benefit to the ridering method as opposed to the rate up method is that the monthly premium does not increase.

How To Protect Yourself From Being Denied For A Pre-Existing Condition

The most important thing you can do to safeguard yourself from running into a problem with a pre-existing condition not being covered is to always maintain health insurance coverage. Keeping continuous coverage will always be the number one way to stay out of health insurance crisis – by keeping continuous coverage you make yourself eligible for a number of programs that are mandated by Federal law to make sure US citizens can get and keep health insurance (HIPAA, COBRA, and others).

If you are having an issue with a pre-existing condition you will want to compare multiple insurance company’s offers and speak with an agent familiar with your state’s laws (preferably and independent agent that can work with multiple insurance companies). Take a few moments to input your home zip code and then compare free health insurance quotes now!

Health insurance for pre-existing conditions is difficult, but not impossible to find.  Thanks to a couple of laws and insurance companies that are willing to cover those considered at risk, there is no reason that you should be without health insurance because of a pre-existing condition. Below you will find basic information to guide you through the process of obtaining fitting and affordable health insurance for your pre-existing medical condition.

Pre-Existing Condition Definitions

Before we go any further we need to define what a pre-existing condition is.  A pre-existing condition is any kind of medical condition that you had prior to taking a health insurance policy (whether or not you received treatment or medical care for the condition does not affect whether the condition is a pre-existing condition).

Each health insurance company has its own rules regarding the waiting time before they will pick up that condition on the policy, as well as how many years they will go back into your medical history in determining if something is a pre-existing condition.  Each insurance company also considers different things as pre-existing conditions, so read all policies thoroughly. 

Enlisting the help of an independent health insurance agent or visiting individual company websites can also be of help in helping you sort through policies and finding a health insurance company that will insure you.

Possible Major Pre-Existing Conditions

Here is a list of some possible major pre-existing health conditions:

  • Pregnancy

  • Obesity

  • Diabetes

  • Arthritis

  • Depression

  • Fibromyalgia

  • Asthma

  • Thyroid Disease

  • Kidney Disease

  • High Blood Pressure

  • Cancer

  • Back Problems

  • Lupus

Possible Minor Pre-Existing Conditions

Here is a list of some possible minor pre-existing conditions:

  • High Blood Pressure

  • High Cholesterol

  • Acne

  • Controlled Diabetes

  • Childhood Asthma

How To Find Health Insurance If You Have A Pre- Existing Condition

Remember that not all insurance companies will handle pre-existing conditions the same way so it can pay to shop around. Use our free quote finder at the top of the page to compare plans, guidelines, and rates from top health insurance companies and then speak with a local independent health insurance agent to compare the specifics. Now that we have that established, lets look at the two laws that take into account pre-existing conditions.

Laws That Impact Health Insurance For Pre-Existing Conditions

HIPAAHealth Insurance Portability and Accountability Act

HIPAA provides the guidelines and rules that must be followed by doctor’s offices to protect a patient’s privacy as well as electronic transfer of information between another doctor’s office or the insurance companies.  It also provides covers the laws governing pre-existing conditions. 

An insurance company is not allowed to make you wait more than a year before covering a pre-existing condition, and if you have no break in insurance you should not have a waiting period for pre-existing conditions. 

This is why it’s important to have another insurance policy in place before terminating your current one.  There is sometimes no waiting period when one signs up for a group health insurance plan but often the waiting period is 12 months. If one signs up for an individual health insurance plan that is HIPAA compatible then there is no waiting period on coverage for pre-existing conditions. Here is some more information on HIPAA health insurance.

COBRAConsolidated Omnibus Budget Reconciliation Act

Not really a law regarding pre-existing conditions, but it does provide for you to maintain any coverage you have through your employer if you are for some reason terminated from your job.  COBRA coverage counts as insurance coverage in determining waiting periods and coverage for pre-existing conditions. Here is some more information on COBRA health insurance.

Pre-Existing Condition Health Insurance Quotes

No matter what you need when it comes to pre-existing health insurance, you will need to get some quotes.  Getting quotes will help you to shop around and see what your best options are.

Different insurers have different underwriting standards so just because you may not have your pre-existing condition covered with one insurance company does not mean that all insurance companies will handle it the same way. You will be able to get an idea of what your health insurance will cost by using our free quote comparison tool to compare multiple companies online. 

Use our quote tool to get started finding health insurance right away!

Health Savings Accounts: A Viable Option To Insurance For Pre-Existing Conditions

A health savings account isn’t a health insurance policy per se.  However, it can help you save money on your out of pocket costs as well as provide supplemental monies if you are issued a limited policy that excludes your pre-existing condition(s) while you are waiting out your waiting period. 

A health savings account allows you to put aside pre-tax dollars into a special account to pay for out of pocket medical costs such as prescriptions, co-pays, visits to the doctor for a pre-existing condition, some over the counter medical supplies and drugs, hearing aids, dental and vision coverage.

An HSA is designed to be paired with a high deductible health insurance plan. Typically, health plans with higher deductibles will have lower monthly premiums and also may in many cases have looser underwriting requirements. Choosing an HSA with a high deducible health plan may allow you to be approved for coverage that you otherwise would not have been eligible for if you had applied for a traditional low deductible plan with copays. Here is some more information on Health Savings Accounts.

High Risk Insurance As Health Insurance For Pre-Existing Conditions

Most states have a high risk health insurance pool for those who are not able to get insurance coverage.  You will probably have higher premiums than you would on a standard insurance plan, but it is an option for coverage. 

The funds for high risk health insurance provided by the state are provided by pooling those that need high risk insurance into one group in order to get group discount rates as well as funds that come from taxes on hospital revenue. 

You will have to be able to provide proof that you have been turned down for insurance, medical coverage by your current insurance company because of a pre-existing condition, or show that you are paying more for insurance than you would through the high risk pool.

It Is Getting Easier To Find A Health Insurance Plan That Covers Pr-Existing Conditions

Pre-existing condition health insurance used to be something that was incredibly difficult to find.  It was next to impossible to get any coverage if you had a pre-existing condition because health insurance companies just didn’t want to take on that burden. People with pre-existing conditions wanting health insurance were seen as a huge risk and great expense that insurance companies did not want to spend money on.  However, today finding pre-existing condition health insurance is not as difficult thanks to new government regulations.

The Impact Of HIPAA On Pre-Existing Condition Health Insurance Plans

The United States government passed new regulations on health insurance in the country.  The regulations are under the Health Insurance Portability and Accountability Act, also known as HIPAA.  HIPAA provides all sorts of health-related protection to Americans.  It helps to create better health insurance plan options and coverage.  One of the main benefits of HIPAA is that it offers great protection for those with pre-existing conditions.

Specifically HIPAA provides that:

  1. Exclusions are limited for pre-existing medical conditions

  2. It makes the process of providing prior coverage proof easier

  3. Protects against discrimination against those with pre-existing medical conditions

HIPAA defines a pre-existing medical condition as a medical condition that received medical care, advice or treatment in the past six months.  The law also states that a new insurer can not withhold coverage for the pre-existing medical condition for more than 12 months or 18 months for someone who enrolls late.  Additionally, credit must be given for any time the person had coverage for the condition under previous insurance.

Where To Find Pre-Existing Condition Health Insurance

With the new HIPAA laws most major medical plans now have to allow coverage for people with pre-existing conditions.  They can no longer deny someone based upon this factor.  What that means for the person with a pre-existing condition is that they can now find pre-existing condition health insurance much easier. A person should be able to go into the main stream and find health insurance that will cover them despite their medical condition or status.

Limitations On Pre-Existing Condition Health Insurance

There are 6 requirements that you must meet in order to determine if you are eligible for HIPAA. (You can learn the 6 requirements by reading our HIPAA health insurance article).

In many cases a person can get regular health insurance, but their pre-existing condition is often excluded.  There are companies, though, that will extend coverage, but to find them a person will have to shop around.  It is important to never try to hide a medical condition for fear of not getting coverage because the company will always find out and they can drop your coverage.  You have to be truthful no matter how difficult that can make things.

If you are lucky enough to have access to a group plan, then you will simply have to wait out the exclusion period and then you can start getting medical coverage.  That can often be expensive, but in the end it is well worth it once you figure all the money you will save once coverage starts.

Overcome Issues With Finding Pre-Existing Condition Health Insurance

Something to think about when you have a pre-existing health condition is alternative coverage options.  You may be able to get a good health insurance plan and then add on optional coverage to handle the expenses of your pre-existing medical condition treatment.  This may be one way to ensure you have coverage.

Another option is to simply get health insurance to cover everything but the pre-existing condition and then seek out alternative discount programs or other options for reduced fee services for the pre-existing condition.

Companies That Offer Health Insurance For Pre-Existing Conditions

Here are some of the companies that provide this type of coverage. Just because these insurance companies will cover pre-existing medical conditions does not mean that they are not going to charge you a higher premium. Keep in mind that the company that will best suit your needs is very much dependent upon your personal situation and the state that you live in. That being said here are some medical insurance companies that offer top notch HIPAA health insurance plans and have other plans that may offer coverage for pre-existing health conditions:

  • Aetna

  • Assurant

  • Blue Cross Blue Shield

  • Celtic

  • Golden Rule (United Healthcare)

  • Humana One

  • Kaiser Permanente

  • UniCare

Compare Health Insurance Quotes For Pre-Existing Conditions Now!

Your search for insurance for pre-existing conditions starts here. Compare multiple companies and find the best company to provide the coverage that you need.

Remember that underwriting standards differ from one insurance company to the next so it pays to shop around and compare rates and plans.

Use the free health insurance quote tool at the top of the page to start your search for health insurance right now!