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What is a Pre-Existing Condition?

If the Affordable Care Act (ACA) is repealed, we could return to a world in which health insurance companies can deny applicants coverage or charge higher premiums if applicants have pre-existing conditions. Need a refresher on what constitutes a pre-existing condition? Concerned about the future of your health insurance costs? Let’s take a closer look at what pre-existing conditions are. 

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Pre-Existing Condition Basics

Before the Affordable Care Act, health insurance companies were permitted to deny coverage or charge higher premiums for coverage on the basis of pre-existing conditions. If you had one of these conditions, you could expect to pay much more for your health insurance or to be unable to buy insurance altogether. By “pre-existing” the insurance companies meant a condition that an individual had before the date coverage began.

Some of the most common pre-existing conditions that led Americans to be denied coverage or charged more for coverage were asthma, cancer and diabetes. Believe it or not, pregnancy once counted as a pre-existing condition, too.

There’s no single list of agreed-upon conditions that counted as pre-existing conditions in the eyes of insurers. Also complicating matters is the fact that different insurers meant different things by “pre-existing.” Some insurers only counted conditions for which an individual had sought medical treatment. Other insurers counted conditions that manifested in symptoms before coverage began. In other words, the second type of insurer could deny your claims or terminate your coverage if they think you showed symptoms of a certain condition before your coverage began, even if you never sought treatment and didn’t know you had a medical condition.

In the pre-ACA world, different states imposed different conditions governing insurance companies’ use of pre-existing conditions. For example, some states allowed insurance companies to “look back” into an applicant’s entire medical history for pre-existing coverage. Other states limited the look-back period to three, six, 12 or 18 months.

Related Article: What’s the Average Cost of Health Insurance?

If You Have a Pre-Existing Condition

What is a Pre-Existing Condition

If you have a pre-existing condition, you may be wondering whether changes to America’s healthcare law could leave you unable to buy health insurance – or unable to buy affordable health insurance – on the individual market. One of the most popular features of the Affordable Care Act is that it prohibited insurers from denying coverage to those with pre-existing conditions and from charging those with pre-existing conditions higher premiums. However, the popularity of that feature is no guarantee that it will stay in place.

And it’s not just health insurance. Having a pre-existing condition can make it harder to buy disability insurance and life insurance, too. One thing that’s not a good idea is failing to disclose your condition when you’re applying for any kind of insurance. When you sign an application for disability or life insurance coverage, you’ll be warned that failure to disclose a condition could result in termination of coverage.

Find out now: How much life insurance do I need?

Bottom Line

What is a Pre-Existing Condition?

There’s a lot of uncertainty in the healthcare world at the moment. If you have a pre-existing condition, now is a good time to beef up your emergency fund so that if your healthcare or health insurance costs go up, you will have a financial cushion.

Photo credit: ©iStock.com/monkeybusinessimages, ©iStock.com/sturti, ©iStock.com/alexskopje

Amelia Josephson Amelia Josephson is a writer passionate about covering financial literacy topics. Her areas of expertise include retirement and home buying. Amelia's work has appeared across the web, including on AOL, CBS News and The Simple Dollar. She holds degrees from Columbia and Oxford. Originally from Alaska, Amelia now calls Brooklyn home.
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