Pre-Existing Conditions

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Written by Trusted Choice

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Reviewer: Jeffrey Green Reviewed by Jeffrey Green
Reviewer: Jeffrey Green
Reviewed by Jeffrey Green

Jeff Green has held a variety of sales and management roles at life insurance companies, Wall street firms, and distribution organizations over his 40-year career.  He was previously Finra 7,24,66 registered and held life insurance licenses in multiple states. He is a graduate of Stony Brook University.

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For years, people who had been diagnosed with chronic health problems found it difficult, if not impossible, to purchase health insurance on the private market. Those who did manage to obtain coverage often paid premiums that were much higher than those paid by most people in their age bracket. 

This hindrance to coverage forced many into bankruptcy, because they were forced to pay for their medical coverage without the benefit of a health insurance plan. The Affordable Care Act (ACA), which went into effect on January 1, 2014, was passed to change that.

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Facts about Pre-Existing Conditions Prior to the Passing of the ACA

  • In 2010, ProPublica reported that health insurance providers turned down coverage for 1 out of 7 people because of pre-existing conditions.
  • This resulted in more than 651,000 people being denied health insurance by the top four insurance companies over a three-year period.
  • Between 2007 and 2009, the number of people who were denied coverage for pre-existing conditions increased as much as 49%.

What Was the Problem with Pre-Existing Conditions before the ACA?

Before the Affordable Healthcare Act was passed, insurance companies providing policies on the private market were free to discriminate against applicants based on their age, health, and the existence of pre-existing conditions. 

This put a lot of people in a precarious position, particularly during the recession, when many people lost their jobs and, as a result, their healthcare benefits.

Some who had recently lost their jobs had the option to buy into COBRA to retain their coverage, but this came at high rates, since the coverage was no longer subsidized by their employers.

Many people with chronic health problems, and pregnant women who needed prenatal obstetric care, found that they were unable to purchase health insurance on the private market because of their conditions. 

Some of these were people who’d previously had coverage and were under a doctor’s care, but lost that coverage for any number of reasons including job loss, job change, divorce, or aging out of their parents’ insurance plan.

These people had two options. They could forgo treatment for their conditions, which often led to more serious problems that become far more expensive to treat; or they tried paying for their care out of their own pockets, often eventually succumbing to bankruptcy. 

How Did the ACA Help Those with Pre-Existing Conditions?

When the ACA went into effect on January 1, 2014, insurance companies were no longer allowed to refuse coverage or charge higher premiums to people with pre-existing conditions. Because of this, many people who wanted to purchase health insurance finally had affordable options open to them.

This rule also applies to health-plans for the needy, such as Medicaid and the Children's Health Insurance Program (CHIP). Prior to the passing of the ACA, even these government-run programs had the option to turn down applicants who suffered from pre-existing medical conditions.

The only plans that are excluded from this ruling are those that are “grandfathered,” meaning they are existing plans that people with pre-existing conditions may have purchased at higher rates. 

In order to receive the benefit of the ACA ruling, these people would need to purchase a new health insurance plan through the healthcare marketplace. 

If this is something that affects you, an independent insurance agent can help you find a plan that will enable to you to keep the doctors you currently have.

How Can I Get Help Finding Affordable Health Insurance?

Whether or not you have a pre-existing condition, if you are in the market for affordable health insurance, navigating through your many options can be confusing. 

With a variety of healthcare plans offering different deductibles, copays and coverage amounts, it can be hard to decide which is best for you and your family. 

An independent agent can help. Contact an agent near you to learn more and to get answers to all of your insurance-related questions.

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