Does Insurance Cover Pre-existing Conditions?

Health insurance makes quality health care more affordable for those who need it. Unfortunately, the best time to purchase health insurance is before you need it, leaving the uninsured suffering from pre-existing health conditions with a difficult path to finding coverage. Thanks to provisions in The Affordable Care Act and the Health Insurance Portability and Accountability Act, it is becoming easier for Americans to find coverage, regardless of their health conditions.

Health Insurance

• Health insurance companies are for-profit businesses that seek to make a profit over the life of your insurance policy. When you apply for private health insurance with a pre-existing condition, you may receive a denial of coverage for your condition, or you may receive coverage for your condition at an increased monthly premium.

The Affordable Care Act

• With the passage of The Affordable Care Act in 2010, lawmakers sought to change the policies of health insurance companies that single out individuals with less than perfect health. The law includes provisions that will prevent health insurers from denying coverage or charging unfair premiums for policyholders with pre-existing conditions by January 2014. Part of the law enforcing these new rules became effective in September 2010, protecting children from coverage denials based on health conditions.

PCIP

• Until The Affordable Care Act becomes fully effective in 2014, adults suffering from pre-existing conditions can apply for health coverage through the federal pre-existing condition insurance pool (PCIP). To qualify for coverage under the PCIP, you must have been denied insurance due to a pre-existing condition and be without insurance coverage for at least six months prior to applying. If you meet these conditions and are a United States citizen or legal U.S. resident, the PCIP will provide you with full coverage insurance at affordable, nondiscriminatory premium rates.

HIPAA

• The Health Insurance Portability and Accountability Act (HIPAA) includes laws that seek to provide employees participating in group health insurance plans at work with protection from health insurance discrimination. Under the law, your employer's health insurance provider cannot deny you access to health insurance due to a pre-existing condition once you qualify for coverage. Furthermore, insurance companies cannot exclude benefits for a pre-existing condition for more than one year following enrollment unless you enroll late, at which time your employer's health insurance provider can wait up to 18 months before covering a pre-existing condition. However, if you had health coverage for your pre-existing condition in the 63 days preceding your enrollment in your employer's health plan, there is no waiting period before the insurer will cover your pre-existing condition.