What Is a Preexisting Condition?

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A preexisting condition is a medical problem that you have before you apply for a health insurance policy. Before the Affordable Care Act (ACA), also known as "Obamacare," insurance companies could charge a higher rate or deny you coverage if you had a preexisting condition.

Since 2014, companies have not been able to consider your health status when they set rates or decide if they will sell you regular health insurance. However, short-term health plans can still deny coverage or charge higher rates based on your preexisting conditions.

What is considered a preexisting condition?

A preexisting condition is any medical issue that you had before your health insurance coverage started.

Some common preexisting conditions are diseases like cancer, diabetes, asthma, alcohol and drug use disorders and mental health illnesses.

Historically, many health insurance companies defined preexisting conditions broadly. For example, before the Affordable Care Act was passed, pregnancy was often considered a preexisting condition and could be a reason to deny coverage.

Common preexisting conditions

  • Cancer
  • Diabetes
  • Heart disease
  • Asthma
  • Depression
  • Kidney disease
  • Hypertension
  • Obesity
  • Dementia
  • Epilepsy
  • Respiratory infections
  • Arthritis
  • Hemophilia
  • Hepatitis
  • Pregnancy
  • Smoking
  • Cerebral palsy
  • Diarrhea
  • High cholesterol
  • Multiple sclerosis
  • Stroke

By denying coverage to or charging higher rates to people with preexisting conditions, insurance companies were able to keep costs down and charge healthier people lower rates. However, it meant many Americans couldn't get affordable health insurance.

Can you get health insurance with a preexisting condition?

Yes, all regular health insurance plans must cover preexisting conditions. Under Obamacare, health insurance companies are not allowed to consider preexisting conditions when selling health insurance coverage.

Before the Affordable Care Act came into effect in 2014, insurance companies commonly looked at your health history, a process known as medical underwriting. Companies could deny you coverage or charge you a higher rate based on your health.

Some companies would sell health insurance plans that specifically excluded coverage for preexisting conditions. These limits in coverage could last for a set period or indefinitely.

Open enrollment

Typically, you can only buy regular health insurance plans on ACA marketplaces between Nov. 1 and Jan. 15, a period known as open enrollment. Open enrollment exists to discourage people from waiting until they're sick to buy health insurance.

You cannot buy a regular health plan outside of open enrollment unless you qualify for what's called a special enrollment period by experiencing a major life change, such as moving to a new area, getting married or divorced or losing your existing health coverage due to job loss or a death in the family. These major life changes are also known as IRS qualifying events.

Short-term health insurance

Companies are allowed to consider preexisting conditions for short-term health insurance.

Short-term health insurance policies aren't subject to ACA rules. That means companies can deny you coverage or charge you higher prices if you have a preexisting condition.

Short-term health insurance plans also don't have to offer the same essential coverage as regular health insurance plans. You might consider a short-term health insurance plan if you need temporary coverage and you're unable to buy a regular health insurance policy. However, it's a bad idea to have a short-term policy for more than a few months.

If you lost your health insurance because you were laid off or fired, you should consider maintaining your old coverage with COBRA. While COBRA tends to be more expensive compared to short-term plans, you'll likely have better coverage.

Alternatively, you could check if you qualify for a special enrollment period. This would allow you to buy a regular health plan outside of the normal open enrollment period.

Short-term health insurance isn't available in all states.

Other types of insurance

Preexisting conditions matter for more than just health insurance. Life insurance companies may deny you coverage based on a preexisting condition. They may also charge you a higher rate or offer a lower payout based on your current medical condition.

Pet insurance also commonly factors in preexisting conditions. That means you may have a more difficult time finding affordable coverage for your dog, cat or other pet based on their health. [/panel]

Frequently asked questions

What are preexisting conditions?

Preexisting conditions refer to a medical problem that you have before you buy health or life insurance. Common preexisting conditions include diabetes, asthma and mental health disorders.

Companies can no longer consider preexisting conditions when selling most health plans.

Is a pregnancy a preexisting condition?

By law, pregnancy cannot be labeled a preexisting condition. However, before 2014 some health insurance companies considered pregnant women to have a preexisting condition.

Does health insurance cover preexisting conditions?

Yes, all regular health insurance plans are required to cover preexisting conditions. Under the Affordable Care Act (ACA), insurance companies can't deny coverage or charge a higher rate because of a preexisting condition.

Sources and methodology

Information about Affordable Care Act (ACA) rules and preexisting conditions came from HealthCare.gov and the U.S. Department of Health and Human Services (HHS). Other data about pregnancy coverage came from the Kaiser Family Foundation (KFF).

Editorial note: The content of this article is based on the author's opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.