Pre-Existing Condition

What is a pre-existing condition?

A pre-existing condition is a health problem that someone had before starting their new health coverage. Insurance companies are unable to refuse coverage of pre-existing conditions, and they cannot charge someone more because of them or limit the benefits offered for that condition.

Most pre-existing conditions are chronic or long-term, with some examples including:

  • Diabetes
  • Asthma
  • Cancer
  • Pregnancy
  • Chronic obstructive pulmonary disease (COPD)   

With the introduction of the Affordable Care Act (ACA) in 2010, insurance companies can no longer deny coverage or charge differently based on pre-existing conditions. This helps ensure better and more affordable health care for all, regardless of their health conditions.

Do “grandfathered” health plans cover pre-existing conditions?

The one exception to coverage of pre-existing conditions is with “grandfathered” health plans, which do not have to cover them. Grandfathered health plans include those purchased on or before March 23, 2010, and instead of being sold through the Marketplace, they were sold through insurance companies, brokers, or agents.