Health insurance can cover pre-existing medical conditions, but policies may have restrictions. Factors affecting coverage include waiting periods, exclusions, premiums, and disclosure. It’s important to check exclusions, premiums, and disclosure lists before purchasing or renewing a policy. Choosing a plan that suits your needs and budget, or seeking specialized plans like critical illness or disease-specific plans, can help avoid claims.
Yes, you can get health insurance if you have pre-existing conditions. Thanks to the Affordable Care Act (ACA), health insurance companies cannot deny you coverage or charge you more just because you have a pre-existing condition. This means that you have the same rights to health insurance as anyone else, regardless of your health history.
What is a pre-existing condition?
A pre-existing condition is any health condition that you had before you enrolled in a new health insurance plan. This can include chronic conditions such as asthma, diabetes, and heart disease, as well as acute conditions such as a broken bone or cancer.
What are my options for health insurance if I have pre-existing conditions?
There are a few different options for health insurance if you have pre-existing conditions. You can:
- Purchase a health insurance plan through the Health Insurance Marketplace. The Health Insurance Marketplace is a government-run website where you can compare and purchase health insurance plans from different insurance companies. All Marketplace plans are required to cover pre-existing conditions.
- Purchase a health insurance plan directly from an insurance company. Some insurance companies offer health insurance plans to individuals with pre-existing conditions. However, these plans may be more expensive than Marketplace plans.
- Get health insurance through your employer. If you are employed, your employer may offer health insurance as a benefit. If your employer offers health insurance, you are guaranteed coverage, even if you have pre-existing conditions.
What should I consider when choosing a health insurance plan if I have pre-existing conditions?
When choosing a health insurance plan if you have pre-existing conditions, there are a few things to consider:
- What type of coverage do you need? Make sure to choose a plan that covers your pre-existing conditions. You may also want to consider a plan that covers other important benefits, such as prescription drugs and mental health care.
- What is your budget? Health insurance premiums can vary widely, so it is important to choose a plan that fits your budget. Be sure to factor in the cost of premiums, deductibles, copays, and coinsurance.
- What is your network? Some health insurance plans only cover medical expenses from doctors and hospitals within their network. If you have a preferred doctor or hospital, be sure to choose a plan that includes them in their network.
How can I get help choosing a health insurance plan?
If you need help choosing a health insurance plan, there are a few resources available to you:
- The Health Insurance Marketplace. The Health Insurance Marketplace offers free and confidential help with choosing a health insurance plan. You can call the Marketplace at 1-800-318-2596 or visit their website at HealthCare.gov.
- A health insurance broker. A health insurance broker is a licensed professional who can help you compare and purchase health insurance plans from different insurance companies.
- Your local government. Many state and local governments offer programs to help people with pre-existing conditions get health insurance. You can contact your local government to find out about these programs.
Conclusion
If you have pre-existing conditions, you have the same rights to health insurance as anyone else. There are a few different options for health insurance available to you, and there are resources available to help you choose the right plan for your needs.
Additional information for people with pre-existing conditions
- Waiting periods. Some health insurance plans have waiting periods for pre-existing conditions. This means that you may have to wait a certain period of time after you enroll in the plan before your pre-existing conditions are covered. Waiting periods can range from a few months to a few years.
- Lifetime limits. Some health insurance plans have lifetime limits on coverage for pre-existing conditions. This means that the plan will only pay a certain amount of money for your pre-existing conditions over your lifetime.
- Essential Health Benefits. All health insurance plans sold through the Health Insurance Marketplace and most plans sold directly from insurance companies are required to cover a set of Essential Health Benefits. Essential Health Benefits include coverage for doctor’s visits, hospital stays, prescription drugs, and mental health care.
If you have any questions about health insurance for people with pre-existing conditions, please contact the Health Insurance Marketplace or a health insurance broker for assistance.
