Eliminating Preexisting Conditions in Health Insurance

Posted by Amanda on April 19, 2011

I’ll never forget the time when I was in the three month waiting period between graduating college and getting my own health insurance plan through my first job. I had lost coverage on my mother’s health plan because I had graduated college. Instead of picking up my own plan for those measly three months, I figured I would just wait it out.

Then a really good friend of mine told me that her boyfriend had had the foresight to sign up for a catastrophic (high-deductible) short-term plan just in time to have his appendix burst. She shuddered as she thought of how horrific his financial future might have been had he not signed onto that plan. The story was enough to send me to the nearest insurance agent’s office.

The form for a high-deductible plan covered all of the basics: my personal information, height, weight, whether or not I smoked or had had major surgery. But then something caught my eye: was I pregnant?

I took the clipboard up to the insurance agent and asked what that had to do with anything (for the record, I was not pregnant). She said that it counted as a Preexisting Condition, and that I could be denied coverage for it.

My mind started racing. Pre-existing Condition? Of course pregnancy is a Pre-existing Condition, as well as a pretty normal state of life. Why on earth would that exclude you from finding health insurance? Up until that moment, I thought that Pre-Existing Conditions were only for the most terminal of illnesses, such as cancer or incurable diseases, and I was horrified to say the least.

Pre-existing Conditions and Health Insurance

Working for a company that offers health insurance is a sure fire way to get you and your family covered no matter what conditions or genes you bear. However, many jobs have cut health benefits substantially and lots of people are trying out their entrepreneurial skills by starting their own companies, so it is more common now that Americans need to apply for their own health insurance policies.

Before an insurance agent will insure your home, they inspect it to see what defects it has, and what potential calamities could occur in the future.

Health Insurance companies do the same thing, but with people. This is why they are concerned with your height, whether or not you smoke and could develop lung cancer in the future, whether or not your weight indicates you could turn obese and end up costing them catastrophic amounts of money down the road.

And then, they either disqualify you from their insurance plan, put you on an exclusion period of time in which no claims for your Preexisting Condition will be accepted of between 6-18 months (perhaps it would have been 9 months if your Pre-existing Condition is pregnancy—how convenient), or they charge you a higher premium based on the information.

Other conditions that typically disqualify a person from health insurance include: Type 2 diabetes, heart disease, cancer, high blood pressure, asthma, etc.

When you or Your Child Will No Longer Be Excluded due to Pre-Existing Conditions

The Patient Protection and Affordable Care Act, signed into law in March 2010, should eliminate the Pre-existing Condition conundrum many Americans find themselves in.

Since September 2010, healthcare insurance could no longer deny claims or coverage under their parent’s healthcare plan for children under 19 years of age because of preexisting conditions. Insurance companies will also no longer be able to insure that child under their parents’ plan, but not accept claims for their Pre-existing Condition.

In 2014, the same will be true of adults (19 years and older). 

Preexisting Condition Insurance Plan (PCIP)

What can you do if you find yourself in the Pre-Existing Bermuda Triangle right now?

For those of you finding it difficult to get insurance because you are pregnant, in-between work and have Pre-existing Conditions, are self-employed and have been denied coverage, etc., this new act has a plan B to offer you that began last year. Every state must now have a PCIP for high risk people.

The following must be true for you to qualify: you have been uninsured for six months or more, you have been denied coverage or denied coverage for your specific Pre-existing Condition, you have a Pre-existing Condition, and you are a US citizen or national, or you are lawfully present in the United States. 

Check out the healthcare.gov website and go through the questions to see what is offered in your individual state, and whether or not you qualify. While this covers you for right now, in the near future you will be able to sign up for normal healthcare without being denied thanks to this new legislation.





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Comments to Eliminating Preexisting Conditions in Health Insurance

  1. Me and my husband are self-employed. We recently applied for individual health insurance with BCBS and received a quote for a plan with $2,500 deductible for a premium we could afford. However, when we decided to apply, the underwriter increased my 13-months daughter premium 150% because of a something they considered as a preexisting condition. We hade to take it anyway, since it was the best option available.

    Vale

    • That is quite the increase! Thank you for sharing your experience with us.

      Amanda

  2. The PCIP is a complete scam. As they say, the devil is in the details. That six month waiting period is until you can APPLY. So you have to play medical roulette, drop whatever skanky partial insurance (with exclusions) that you can get, and hope that the PCIP is still available when you can apply.

    The PCIP was a great way to announce *something* but preserve Insurance company profits on those of us that have expensive partial insurance and aren’t willing to gamble on dropping that so that we can get full PCIP insurance. Do a web search on the low numbers of PCIP enrollments. I tell people, if you can afford it, you are probably paying for whatever partial insurance you can get, and that makes you not eligible.

    Screwed

  3. In the US, having a diagnosis for certain types of depression can also be a preexisting condition. It’s disturbing that depression is on the same list as AIDS! I know insurance companies are businesses and need to make money. It’s just frustrating that the people who can’t get medical coverage are the ones who often need it most. Great article, thanks for spreading the knowledge!

    Katie

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