Health Insurance with a Preexisting Condition

Buying Health Insurance

The cost of healthcare is at an all-time high. As someone with a serious condition, you want to make sure that you can afford medical care. A robust health insurance plan is your key to making sure that you can pay for appointments with specialists, therapy, prescriptions, and anything else that goes with managing or recovering from your condition.

You may assume that since you have a preexisting condition, you’ll pay a higher premium than someone who is in perfect health. However, an insurer cannot reject you, refuse to pay for health benefits pertaining to your illness or injury, or charge you a higher premium because of your condition. Once you’re enrolled in the health insurance plan, the insurer can’t deny you coverage or raise your rates based only on your health. Smoking rates can be higher than non-smoking rates, however.

Are Preexisting Conditions Covered?

Preexisting conditions used to be a significant obstacle to acquiring health insurance before the Affordable Care Act was passed, requiring that those with medical conditions jump through hoops to get necessary medical care and prescription drug coverage. Oftentimes, those with preexisting conditions either couldn’t get health insurance at all, couldn’t get coverage for any care related to their medical conditions, or had to have a loved one provide coverage through their employer’s health insurance coverage.

Health Insurance plans can no longer discriminate based on preexisting conditions. Prior to 2014, when purchasing individual healthcare with a preexisting condition, an insurer might have declined covering your condition, or they might have denied you coverage altogether. However, now with the Affordable Care Act, insurers must provide individual health insurance (with the 10 essential health benefits) that can no longer exclude, limit, or deny coverage solely because of a preexisting condition.

There will no be annual or lifetime limits on the 10 Essential Health Benefits. It no longer matters what medications you are on, your height or weight, how old you are, how young you are, your gender, what preexisting conditions you have, if you are pregnant, if you’ve had a ton of medical bills in the past, genetic information or disabilities. Nothing matters. You qualify. You cannot be turned down for health issues.

Some factors that may affect your premium is if you smoke, your age, the number of family members you are covering, and your income. But factors affecting your health will no longer cause your premium to go up in price.​

Can I Get Covered?

While it’s now much easier to obtain health insurance coverage for preexisting conditions, not every health insurance plan provides coverage for those with previously diagnosed medical conditions. If you have a preexisting condition, it’s important to ensure that the health insurance plan you choose provides coverage for your condition. ANY medical plan that is ACA (Obamacare), is a “Qualified Health Plan”, group coverage through an employer, or Government plan like Medicaid/Medicare/VA will cover preexisting conditions.

On-Exchange vs. Off-Exchange

On exchange marketplace health insurance plans (Nevada Health Link) and Off Exchange ACA plans are both required to provide coverage for the 10 essential health benefits.

These benefits include:

• Ambulatory patient services
• Emergency services
• Hospitalization, including surgery and overnight stays
• Maternity care, including prenatal and postnatal care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and device
• Laboratory services
• Preventative care and wellness services, including chronic disease management
• Pediatric care

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On Exchange Marketplace Plans

In addition to the 10 essential health benefits, on exchange Marketplace health insurance plans must also provide birth control coverage and breastfeeding coverage.

These benefits are the minimum requirements for all on exchange Marketplace plans. The exact services covered by different plans may vary from one state to another. Some plans may have additional benefits, such as vision and dental coverage and medical management programs for specific needs like diabetes or weight management.

Off Exchange Health Insurance Plans

Off exchange plans do not provide government subsidies, but still have preexisting conditions covered if they are “qualified health plans” (ACA or Obamacare).

In most cases, if you have a preexisting condition and you’re looking for health insurance, “qualified health insurance plans” (ACA or Obamacare) both on and off exchange are the best option for you. All on exchange Marketplace health insurance plans are required to provide coverage for preexisting medical conditions, meaning that no insurance plan can reject you or refuse to pay for the 10 essential health benefits. In addition to this, once you’ve enrolled in a plan, your rates can’t go up solely based on your health. The only way your rate may be higher than someone else is for tobacco use.​

Short Term Health Insurance

Recently, access to short-term health insurance plans has been expanded. These policies are designed to provide coverage during transition periods such as, when someone is unemployed or is coming off their parents’ health insurance plan. In most cases, short-term health insurance plans are only a viable option for applicants who are healthy and have few preexisting conditions. Short term plans are not “qualified health plans” (ACA or Obamacare) and are medically underwritten. We recommend that you use these plans sparingly if possible. Please check with your agent if you can qualify and/or afford a qualified health plan as a first option. Your window of getting into a qualified health plan is normally 60 days, and once that window is closed, you have to wait for the next open enrollment period, unless you have a “life event” like marriage, birth, etc.

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