Can you be turned down for pre-existing conditions?

Asked by: Vaughn McLaughlin  |  Last update: January 13, 2026
Score: 4.8/5 (17 votes)

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

Can preexisting conditions be denied?

Coverage for pre-existing conditions

No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you're enrolled, the plan can't deny you coverage or raise your rates based only on your health.

What do insurance companies consider pre-existing conditions?

A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer.

What is the exclusion for pre-existing conditions?

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

How far back do insurance companies look for pre-existing conditions?

To determine if a condition is pre-existing, insurers examine medical history, treatment records, and diagnosis reports. They may use “look-back periods,” which are specific timeframes—typically six months to a year before coverage begins—to review medical history.

Your Health Claim Could Be DENIED! (Here's Why) | Health Insurance Pre-Existing Conditions Explained

15 related questions found

How far back is a pre-existing condition?

A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.

How do insurance companies determine pre-existing damage?

Adjusters often rely on photographic evidence from before and after the accident. Comparing these can help determine whether damages were pre-existing. Expert assessments. Sometimes, insurance companies will employ the expertise of mechanics or collision repair specialists to assess the vehicle's condition.

What is the usual minimum waiting period for a pre-existing condition?

The length of time before the start date of coverage during which a condition would be considered pre-existing varies, and can be anywhere from 30 days to 6 months or longer.

What does a pre-existing condition limitation not apply?

Insurers in some states could have restrictions added on whether they can include a pre-existing condition exclusion period. Today, insurers cannot deny coverage to somebody based on pre-existing conditions, nor charge more.

Will my new insurance cover an old medical bill?

Conclusion: Will My Insurance Cover an Old Medical Bill? Your insurance will only cover an old medical bill if that insurance was in effect on the date medical services were provided. If you did not have health insurance in effect on the date of service, any new insurance won't pay for that old medical bill.

What is the waiting period for pre-existing disease?

Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 3 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 2 to 3 successful years with the insurer.

Do any insurers cover pre-existing conditions?

In some cases, you'll also need to give the insurer access to your medical records. The insurer can then decide if they want to insure you or not for a pre-existing condition. So, you may be able to get insurance for a pre-existing medical condition that is excluded with Moratorium underwriting.

How many Americans have pre-existing conditions?

A pre-existing condition is a health diagnosis that exists before someone tries to enroll in a new health insurance policy. Previous research estimated that nearly 27% of US adults aged 18 to 64 years had a declinable (ie, pre-existing) condition.

What counts as a pre-existing condition?

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

What states have pre-existing condition protections?

In 2019 and 2020, at least 15 states (CT, DE, FL, HI, IN, LA, MD, ME, NH, NJ, NM, NV, OR, VT, and WA) have enacted laws to create or study coverage protections against pre-existing condition exclusions or coverage of all essential health benefits (EHB) provided for in the Affordable Care Act (ACA).

Can I be denied health insurance because of a pre-existing condition reddit?

It's been over a decade. Obamacare got rid of the pre-existing conditions and a bunch of other things. It also created a marketplace where people who don't get insurance through their employer can buy insurance that meets the requirements of the law (we say that it's ACA-compliant).

Can insurance decline preexisting conditions?

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can't charge women more than men.

What is the limitation period for pre-existing conditions?

A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee).

What is a pre-existing condition exclusion waiver?

What is the Waiver of Pre-Existing Medical Conditions in Travel Insurance? Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy.

How far back does pre-existing condition last?

A group health plan can count as pre-existing conditions only those conditions for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. This period is known as the “look back” period.

How soon after getting insurance can you get surgery?

Depending on your provider, insurance companies can take anywhere between 1-30 days to approve the request. Stay in communication with your care team, as timing for approval varies between insurance providers.

Can I buy health insurance and use it immediately?

Many, but not all, short term health insurance plans can take effect the day after your application is received.

How does car insurance know about pre-existing conditions?

Damage inspection can be performed during policy purchase or after a car accident. In both cases, the individual performing the inspection may uncover pre-existing damage. If you didn't report the damage, your insurer might still know about pre-existing damage through damage inspection.

How to negotiate property damage with insurance company?

Here's what you need to know about negotiating a fair settlement for property damage in California.
  1. Know What You Want from the Insurance Company. ...
  2. Ask to See How the Insurer Valued Your Car. ...
  3. Don't Accept a Lowball Settlement Offer. ...
  4. Emphasize the Points in Your Favor. ...
  5. Document Everything Throughout the Process.

What are 3 factors that insurance companies look at to determine how much your insurance is going to cost?

What determines your car insurance rates
  • Location.
  • Driving record.
  • Credit history.
  • Gender.
  • Age.
  • Marital status.
  • Claims history.
  • Car make and model.