Health Insurance Coverage for People With Pre-existing Conditions

Finding health insurance with a pre-existing medical condition can prove difficult at best for many Americans. Many are denied health insurance for even the most common health conditions, including asthma and pregnancy, causing financial distress and even an inability to pay for medical care. The enactment of the Affordable Care Act seeks to eliminate discrimination by insurance companies against applicants with pre-existing conditions.

The Affordable Care Act

• Beginning in 2014, the Affordable Care Act, a health reform law passed in 2010, will affect all Americans who are struggling to find health insurance to cover their pre-existing health conditions. Starting that year, no insurance company will discriminate against unhealthy individuals by denying health insurance coverage based on pre-existing health conditions.

Children

• A portion of the Affordable Care Act affecting children with pre-existing conditions went into effect in September 2010. As of that month, no health insurance provider can deny coverage to a child under age 19 for health reasons. Though the law helps many parents without health coverage for their children, many insurance companies stopped offering child-only health insurance policies when the law went into effect. This means that parents must first purchase a health insurance policy for themselves and add their children as dependents on the policy in order to find private health coverage for their children.

PCIP

• Another portion of the Affordable Care Act provides for a federally regulated pre-existing condition insurance plan, or PCIP pool. The health plans available from the insurance pool provide broad coverage for all health conditions without charging higher premiums due to the policy-holders health conditions. Furthermore, the PCIP pool doesn't qualify applicants based on income. Instead, applicants must be legal residents of the U.S. and be health insurance-free for the six months prior to applying for PCIP.

Other Options

• Some people with pre-existing health conditions have other options depending on their life circumstances. For example, some states offer high-risk health insurance pools similar to the federal PCIP. Additionally, many low-income and disabled U.S. residents have access to government health benefits through Medicaid, the Children's Health Insurance Program and state health programs. These government health programs provide broad coverage and do not exclude benefits for pre-existing conditions. Eligibility varies by state.

Employee Group Plans

• Thanks to the 1996 Health Insurance Portability and Accountability Act, which regulates employer group health plans, employers are prohibited from discriminating against employees based on pre-existing conditions. So long as an employee received no health care for his health condition in the six months prior to joining the group health plan, group insurance must cover the condition, regardless of how long the condition has been present or whether the employee received health care for the condition prior to the six-month probationary period. If the employee did receive care for his condition in that six-month period, the group health plan can only exclude the condition from coverage for 12 to 18 months under federal law.