Do pre-existing conditions still apply?
Asked by: Filomena Connelly | Last update: January 16, 2026Score: 4.1/5 (59 votes)
Can I be denied health insurance because of a pre-existing condition?
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.
When did pre-existing conditions end?
Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.
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 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'.
Understanding Pre-Existing Conditions
How do insurance companies know if you have a pre-existing condition?
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.
What is the limitation period 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.
What is the waiting period for pre-existing diseases?
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.
Can Medicare refuse to cover pre-existing conditions?
Yes. Medicare Advantage (MA) plans won't reject your enrollment if you have a preexisting condition.
What illnesses are considered pre-existing conditions?
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 percentage of Americans have pre-existing conditions?
Introduction. According to a new analysis by the Department of Health and Human Services, 50 to 129 million (19 to 50 percent of) non-elderly Americans have some type of pre-existing health condition. Up to one in five non-elderly Americans with a pre-existing condition – 25 million individuals – is uninsured.
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.
Is anxiety a pre-existing condition?
In the health insurance world, a pre-existing condition is any injury, sickness or condition that exists before the date an insurance policy takes effect. Examples include asthma, diabetes, anxiety, depression, high blood pressure, high cholesterol and so on.
How do I get insurance with a pre-existing condition?
Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.
What counts as a pre-existing medical condition?
You may have gone for tests, scans or other investigations before you had health insurance and only received a diagnosis later. It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance.
Is high cholesterol a pre-existing condition?
Does high cholesterol count as a pre-existing medical condition? Yes. High cholesterol is considered a pre-existing medical condition by insurance companies, along with similar conditions like high blood pressure.
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.
Can people with preexisting health conditions no longer be denied coverage?
Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.
Is high blood pressure a pre-existing condition?
A pre-existing condition can be something as common as high blood pressure or allergies, or as serious as cancer, type 2 diabetes, or asthma—chronic health problems that affect a large portion of the population.
What is the 12 month waiting period for pre-existing conditions?
12-months Condition Specific Waiting Period – this is a period during which a member is not entitled to claim benefits in respect of a condition for which medical ad- vice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which an application for membership was ...
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.
Is arthritis a pre-existing condition?
Examples of pre-existing conditions include: Chronic diseases (hypertension, heart disease, chronic obstructive pulmonary disease (COPD)) Mental health disorders (depression, anxiety, PTSD) Autoimmune diseases (rheumatoid arthritis, multiple sclerosis (MS), Crohn's disease)
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.
Does Medicare cover pre-existing conditions?
Medicare defines a pre-existing condition as any health problem that you had prior to the coverage start date for a new insurance plan. If you have Original Medicare or a Medicare Advantage plan, you are generally covered for all Medicare basics even if you have a pre-existing condition.
Can a health insurance company refuse to insure you?
Insurers cannot refuse to pay for essential health benefits for any pre-existing conditions. Additionally, once you are enrolled, the plan cannot deny you coverage or raise your rates based solely on your health.