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What are Pre Existing Conditions?

Edward Neeman Published: June 14, 2018 Updated: January 26, 2018

Healthy food stethoscope

Getting affordable health insurance for pre existing conditions is a common problem that the majority of people in the nation face. In the guide below, we will discuss further what is considered a pre existing condition, the current law that protects those who suffer from them, and the conditions that qualify as pre existing for health insurance.

What Are Pre Existing Conditions?

Pre existing conditions are health issues that you had before applying for new healthcare coverage. However, a variety of health issues can be typically considered pre existing, anything from heart disease to pregnancy and the majority of kinds of health conditions can lead to healthcare coverage denial. This also includes taking medication for pre existing conditions in the case of diabetes, mental health conditions arthritis, infertility and more. Besides the risk of being denied healthcare coverage, people can also receive excluded coverage for certain conditions and charged higher premiums. Generally speaking, a health condition is considered pre existing if you have been getting medical treatment for it for six months to five years prior to enrolling in affordable health insurance. However, this often varies state to state.

What is the Current Law?

In 2010, the Affordable Care Act was officially passed. This act guarantees that those with pre existing conditions cannot be refused health insurance coverage because of their condition. Additionally, an HMO cannot charge more or refuse to pay for essential benefits for any type of pre existing condition. On top of all that, healthcare providers cannot deny people health insurance coverage or raise premium rates because of their health. This is one of the most popular features of the act. There has been a lot of talk this year about repealing the ACA and replacing it with the American Health Care Act, also known as Trumpcare. While this act has not been passed yet, the government is still trying to get it passed. In its current form, the ACHA does not allow insurers to deny coverage to those with pre existing conditions. However, Trumpcare would let states allow insurance providers to charge higher premiums to those with this sort of condition. As of yet, there is no cause for alarm.

Who Decides What Qualifies as a Pre Existing Condition?

Pre existing conditions are determined by health insurance companies. They decide what conditions qualify as pre existing and which do not. Before the ACA was enacted, you would need to include your health history in your healthcare application. An HMO would also collect personal information from your medical records and other sources. This is no longer the case.

How Many People in the USA are Living With Pre Existing Conditions?

The Department of Health and Human Services released a report in January 2017 that found that 51% of Americans under 65 may have a pre existing condition. This translate to about 131 million people. The chances of developing a pre existing condition increase significantly as people age. Among people between the ages of 55 years and 64 years, 31 million people, or 84%, have at least one pre existing conditions.

Which Conditions Qualify as Pre Existing?

As mentioned above, the majority of states put the responsibility on the HMO to define what a pre existing condition is. Health insurance companies can decide that any diagnosis, test, or preventative measure is considered a pre existing condition. Before the ACA went into effect, conditions like alcohol and drug abuse, mental disorders, and even pregnancy were all considered pre existing. Additionally, during this time, 47% of people with this type of condition who tried to obtain private health insurance was declined coverage, charged more, or received insurance that did not cover their condition. Below is a list of common conditions that insurers considered to be pre existing and, in the past, declinable medical conditions. It was compiled by the Kaiser Family Foundation. Some of the conditions include:

  • Epilepsy
  • Cancer
  • Heart Disease
  • Organ Transplant
  • Hepatitis
  • Obesity
  • Sleep Apnea
  • Cerebral Palsy
  • Paralysis
  • Emphysema
  • Alzheimer's and Dementia
  • Stroke
  • Pneumocystis Pneumonia
  • Kidney Disease
  • Paraplegia
  • Diabetes Mellitus
  • Alcohol or Drug Abuse
  • Multiple Sclerosis
  • Parkinson's Disease
  • Muscular Dystrophy
  • Future Surgery or Hospitalization
  • Congestive Heart Failure
  • Arthritis, Fibromyalgia, and Inflammatory Joint Disease
  • Mental Disorders
  • Pregnancy

If you suffer from one of these conditions or any other deemed pre existing by your health insurance provider, there is no need to worry any longer. Thanks to the Affordable Care Act, conditions like pregnancy and obesity can longer exclude you from receiving the medical care you need, and there are even private health insurance companies that offer coverage for pre existing conditions now. First Quote Health makes finding health insurance for your pre existing condition easy by letting you compare the best rates from the top carriers in your area. Just enter your zip code and get covered today