What Is a Pre-Existing Condition and Why Does It Matter?

What Is a Pre-Existing Condition and Why Does It Matter?

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Amid the hubbub of health care news this past year, you’ve likely seen headlines about pre-existing conditions.

The talk comes as new laws poise short-term health insurance for more widespread popularity in 2019. The pared-down coverage these plans offer tends to come with lower premiums and the flexibility to sign up any time — and now they’re available for 364-day terms in some states. If you’ve compared these budget-friendly options with their more conventional counterparts, you’ve probably heard that pre-existing conditions are a major factor to keep in mind.

But what is a pre-existing condition, exactly, and why do you need to understand them before you make your next health insurance purchase?

Pre-existing Conditions and Health Insurance

The short and sweet definition of a pre-existing condition, according to the federal government, is any kind of health issue you had before enrolling in a new health insurance plan. They cite diabetes, cancer and asthma as examples, though a full list would be much longer, with many conditions up for debate.

Plans covered under the Affordable Care Act (ACA) protect pre-existing conditions, which means you can’t be refused coverage or charged more because you have one. These plans are generally known as “ACA-compliant” and can be bought on or off of the Health Insurance Marketplace.

On the other hand, short-term insurance policies — along with supplemental plans like critical illness and hospital indemnity insurance — aren’t required to comply with the ACA, which means they may not cover pre-existing conditions. This doesn’t mean that none of these plans cover any pre-existing conditions; it all depends on what’s in the fine print in your policy.

What Does This Mean for You?

Wondering why all of this matters? A recent Gallup poll found that 1 in 4 Americans has a pre-existing condition. If that’s you, you should carefully consider all your options and make sure you’re getting the coverage you need.

Since definitions of “pre-existing” and coverage for these conditions vary from insurer to insurer and plan to plan, it’s critical that you review the details of a new potential health plan before buying. What you pay for coverage — or whether certain policies will cover you at all — is at stake. Ask questions like:

  • What is a pre-existing condition according to this plan? Are those conditions covered?
  • Do premium or coverage amounts change based on having a pre-existing condition?
  • What happens if I’m diagnosed with a health problem like cancer or diabetes after signing up for the plan?

Now, pre-existing condition coverage isn’t the only factor that goes into buying health insurance. You’re also going to want to look at cost, term length and payout structure (if applicable), among other things, and there are a few more questions you’ll have to ask to narrow down your search.

For now, though, take a well-deserved minute to relax before diving into the rest. By figuring out pre-existing conditions, you’ve collected a vital piece of the health insurance puzzle, and the end result — a plan that covers exactly what you need it to — is already starting to take shape.

Bana Jobe

Bana Jobe is an award-winning medical writer with over 10 years of experience

All stories by:Bana Jobe

Bana Jobe

Bana Jobe is an award-winning medical writer with over 10 years of experience

All stories by:Bana Jobe