Learn About Pre-Existing Conditions and Their Effects on Health Insurance

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Learn About Pre-Existing Conditions and Their Effects on Health Insurance

Pre-existing medical conditions have had a large impact on the American health insurance industry in the past. However, major medical reforms from the Affordable Care Act (ACA) have greatly changed how pre-existing medical conditions are perceived and treated by insurance companies.

Therefore, if you have a pre-existing medical condition, you will not face the same medical insurance barriers you may have faced before the Affordable Care Act (ACA) was enacted in 2010. It’s important to understand the history behind how pre-existing medical conditions have been dealt with in the past and the changes that have taken place in the health insurance industry through the ACA.

Understanding the process can also give you an idea of how likely you are to be able to continue receiving health care in the future. Below is information about pre-existing medical conditions, including how they are defined, whether or not they have an impact on current health insurance prices and how the ACA has changed health insurance eligibility standards for applicants with pre-existing medical conditions.

What are pre-existing conditions?

The term “pre-existing condition” as it applies to health insurance refers to a condition that existed prior a health insurance applicant’s insurance coverage. Any diagnosed mental or physical ailment that an applicant had before applying for health insurance will be categorized as a pre-existing condition.

A pre-existing condition can be a life-threatening illness such as cancer, diabetes, stroke, kidney disease, hepatitis, multiple sclerosis or heart disease. However, other illnesses that might be considered lesser in nature may also be categorized in the same way. Such ailments include chronic arthritis or acne, which are not life threatening but may still require treatment.

Depression and other mental illnesses are also categorized as pre-existing conditions for insurance purposes. Similarly, substance use disorders are considered to be such a condition. Certain conditions that are not technically illnesses in and of themselves, such as pregnancy or being overweight, are also considered for insurance purposes to be pre-existing conditions.

Prior to the ACA, many insurance companies would refuse to pay for health care costs associated with these conditions, or they would simply charge significantly higher premiums to those with the conditions. In many cases, insurance companies even denied health care coverage to patients with pre-existing conditions.

However, pre-existing conditions have not had the same relevancy under the Affordable Care Act that they had prior to the enactment of the ACA law, because insurance companies are now barred from discriminating against those with pre-existing conditions.

How Pre-Existing Conditions Were Categorized

Pre-existing medical conditions were defined by health insurance companies. Each company can release a list of conditions company executives deem to be pre-existing. However, the conditions mentioned above are now universally considered to be pre-existing by most health insurance companies.

The reason insurance companies made such categorizations is that many pre-existing conditions are guaranteed to need treatment, making applicants with those conditions less desirable for companies that want to limit their costs.

Why Pre-Existing Conditions Matter for Health Insurance Purposes

Prior to the ACA going into effect, pre-existing conditions were stumbling blocks for many applicants seeking to acquire health insurance. Insurance companies were legally allowed to either deny coverage entirely or charge more money to insure applicants with pre-existing medical conditions.

Since many applicants could not afford to pay the high premiums, the number of uninsured Americans was quite high. Many people suffered or died due to their inability to obtain affordable health care.

Before Congress passed the ACA, insurance company representatives were legally able to collect medical records and other information about applicants. Such information was used to categorize applicants prior to the acceptance or denial of insurance applications. Some insurance companies denied claims submitted by applicants with pre-existing conditions entirely, while others simply raised insurance premiums based on those conditions and medical records.

How the ACA Changed the Influence of Pre-Existing Conditions on Health Insurance Rates

The Affordable Care Act (ACA) was created in part to help Americans with pre-existing conditions obtain affordable health care. The ACA was also created as a means of standardizing health care coverage across all states and, in part, regulating the practices used by insurance companies across the United States. Prior to the ACA, insurance companies had relatively few operational restrictions, and insurance applicants and beneficiaries had limited protection options.

Under the ACA, American insurance companies are no longer allowed to deny health insurance coverage to applicants with pre-existing conditions. Additionally, insurance companies may not charge higher premiums to certain applicants based solely on pre-existing conditions. Such changes have been particularly helpful to elderly consumers who tend to have more pre-existing conditions, as well as physically and mentally disabled consumers, as well as those insurance beneficiaries with serious illnesses requiring expensive treatments, such as cancer patients.