Best Coverage for Persons with Pre-existing Conditions

A health visitor talking to a sick senior woman sitting on bed at home.

You may have heard that beginning January 1, 2019, health insurance companies will no longer be able to refuse coverage to people with pre-existing conditions.

This is a significant victory for millions of Americans who have battled cancer, diabetes, heart disease, and other chronic diseases. Nobody should be denied health care coverage because they are sick.

The Affordable Care Act (ACA) was a significant step forward in ensuring that all Americans have access to high-quality health care. But the battle is far from over. You must keep working to improve your healthcare system and ensure that everyone has access to the treatment they require.

What Are Pre-Existing Conditions?

A pre-existing condition is one that you had prior to the start of a new insurance policy. Most health insurance policies exclude pre-existing conditions, leaving people with gaps in their coverage.

The Affordable Care Act (ACA), on the other hand, requires all health insurance policies to cover pre-existing conditions. This means that if you have a pre-existing condition, you cannot be denied health insurance coverage, nor can your insurer charge you more for your policy.

Pre-Existing Condition Coverage Under the Affordable Care Act

Prior to the Affordable Care Act (ACA), also known as Obamacare, people with pre-existing conditions were often denied coverage by insurance companies.

This meant that if you had a health condition like:

  • cancer,
  • asthma,
  • or diabetes, you could be charged more for insurance, or be refused coverage altogether.

The ACA made it illegal for insurance companies to deny coverage or charge more for people with pre-existing conditions. This was a game changer for millions of Americans who had been unable to find affordable health insurance.

Health Insurance Options for People With Pre-Existing Conditions

There are a few health insurance options for persons with pre-existing conditions. One option is to get a policy through the Health Insurance Marketplace. You can also look into getting a policy through an insurance company, or you could join a health insurance cooperative.

How to Determine Eligibility for Pre-Existing Condition Coverage

In order to determine eligibility for pre-existing condition coverage, you must first understand the specific guidelines and criteria related to the coverage. Your healthcare provider will be able to provide you with specific details and answer any questions you may have. 

Generally speaking, the eligibility requirements typically include having a diagnosis from a doctor or healthcare provider. It will serve as proof that you have had 12 consecutive months of treatment prior to submitting the application for coverage, and meeting other criteria as outlined in your plan documents.

Additionally, pre-existing conditions may not be covered if they fall within certain categories such as mental health services or substance abuse treatment. To ensure that you are fully informed about what your coverage includes and excludes, it is important to consult your plan documents or speak with a representative from your healthcare provider. By taking these steps, it can be easier to understand what type of coverage is available for individuals with pre-existing conditions.

Exploring Different Types of Coverage for Persons With Pre-Existing Conditions

It is critical to understand the various options available when researching different types of coverage for people with pre-existing conditions. You may be eligible for a variety of plans, depending on your financial situation and needs, such as private health insurance, Medicare Advantage plans, Medicaid, and Supplemental Security Income (SSI).

Private health insurance plans are generally the most expensive option, but they can provide more comprehensive coverage than government programs. Medicare Advantage plans combine Medicare and a private health plan’s benefits and can provide lower out-of-pocket costs. Medicaid is an income-based program that provides essential health benefits in every state, with different eligibility requirements.

Finally, Supplemental Security Income (SSI) is a federal income supplement program that provides cash assistance to people who are elderly, blind, or disabled and have limited income and resources.

It’s important to note that pre-existing condition policies vary between insurers, so do your homework when looking for coverage.

FAQs on Coverage for Persons With Pre-Existing Conditions

You may have some questions when it comes to coverage for persons with pre-existing conditions, and here are some of the most frequently asked questions.

  • Does coverage for pre-existing conditions exist? Yes, there are many insurance plans that will cover persons with pre-existing conditions. 
  • Is age a determining factor in coverage? No, age is not generally a determining factor in securing coverage. 
  • Are there additional costs associated with pre-existing condition coverage? Yes, there may be an additional cost associated with purchasing a plan that covers pre-existing conditions. 

If you have further questions regarding coverage for persons with pre-existing conditions, please contact an insurance agent for more information.

Things to Remember

When it comes to coverage for persons with pre-existing conditions, there are a few things to keep in mind. 

  • First and foremost, you must understand your rights as an insured person. Make sure you understand your insurance provider’s policies and what their plans cover.
  • Furthermore, if you obtain coverage through your employer, you may be entitled to certain rights under the Family and Medical Leave Act (FMLA).
  • Finally, keep in mind any state-specific pre-existing condition coverage laws that may apply to you. Taking the time to do your homework can help you get the best coverage for any pre-existing conditions you may have.

You may be wondering how the Affordable Care Act affects you if you have a pre-existing condition. The ACA prohibits insurance companies from denying coverage or charging you more because of a pre-existing condition. Furthermore, the ACA requires all health insurance plans to cover preventive services, including pre-existing condition screenings, without charging a copayment or coinsurance.

Your employer or a private health insurance plan may be able to provide coverage for your pre-existing condition. If you are uninsured, the Health Insurance Marketplace may be able to help you get coverage. To learn more about your options, go to or call 1-800-318-2596.