Health Insurance With Preexisting Conditions

Read our Advertiser Disclosure.
Contributor, Benzinga
March 16, 2022

While getting health insurance with a preexisting condition may seem like quite the feat, it isn’t impossible. The good news is that if you go through the right channels, you’ll be able to get coverage no matter what preexisting conditions you have. However, if you purchase a short-term health insurance plan, your insurer might deny you coverage if you have a preexisting condition when you sign onto your policy.

Can You Get Health Insurance With Preexisting Conditions?

You can get health insurance with preexisting conditions, however, not all health insurance offers coverage for preexisting conditions. Whether you can get coverage depends on the insurance provider as well as where you’re getting your health insurance and the type of policy you buy.

Thankfully, the Affordable Care Act (ACA) made it illegal for health insurance companies to deny coverage based on preexisting conditions. This means that any type of long-term health insurance plan you purchase will cover your preexisting conditions. This rule applies to both health insurance you get through your employer as well as any individual or family plan you buy through the Marketplace. 

If you have a preexisting condition, you need to be careful when shopping for a short-term health insurance policy. Part of the reason these types of policies are low priced and heavily regulated is because short-term health insurance providers do not have an obligation to adhere to ACA standards when issuing policies. While you may be able to purchase a short-term health insurance plan, your insurance provider might specify in your contract that they will not cover your preexisting condition. 

How to Disclose Pre-Existing Conditions to an Insurance Carrier

When you apply for short-term health insurance, you may be required to get an assessment of your health. Through the assessment of your health, along with several other factors, the insurer determines your risk and then determines the price of your premium. The assessment is typically a form or questions the insurer asks, and you answer the questions truthfully. Some insurers require you to undergo a medical exam, though this practice is no longer common.

Insurers evaluate your health based on what you tell them. They expect you to tell the truth about your health in its entirety, including disclosing whether you have a preexisting condition. While it may seem easy not to disclose a pre-existing condition, it could hurt you more in the end. If you were to have a medical emergency related to the condition, the insurer could reject your claim.  

Can You Get Health Insurance With Congenital Conditions?

Congenital conditions are conditions that present from birth. A number of congenital conditions can be inherited or caused by environmental factors. Some conditions considered congenital include a cleft lip, heart disease, cystic fibrosis and cerebral palsy. If someone has a congenital condition, they may experience health problems throughout their life, which means they need adequate health insurance. 

It’s now easier than ever to get health insurance if you or a loved one is living with a congenital condition. ACA regulations state that insurance providers cannot deny someone coverage because they have a preexisting condition, including any type of congenital conditions. This rule extends to children enrolled on your plan. 

If you are shopping for a short-term health insurance plan, you will likely not be able to find insurance if you have a congenital condition. If you are able to find an insurance provider who will insure you despite having a congenital condition, it will likely include a clause in your contract that your coverage will not extend to any illness or emergency directly or indirectly caused by the congenital condition. 

How Do Preexisting Conditions Impact Your Premiums?

Health insurance providers within the healthcare marketplace are not allowed to charge you more for coverage if you have a preexisting condition under the Affordable Care Act. However, if you are getting private short-term insurance and going through a non-ACA-compliant provider, your condition may impact your premiums. In this case, your premiums may be much higher than they would be if you were to go through a group plan or not have a preexisting condition. 

Common Preexisting Conditions

A preexisting condition can be categorized as any condition you have before the coverage from your health insurance begins. Most of these conditions are chronic or at least long term. Any condition you’ve been diagnosed with or treated for prior to coverage beginning can be considered a preexisting condition. Some examples of the more common preexisting conditions include:

  • Cancer: Cancer is a group of diseases, meaning it's a broad category. However, all forms of cancer are considered to be preexisting conditions. 
  • Epilepsy: Epilepsy is a brain disorder that causes seizures. All types of epilepsies are considered preexisting conditions. 
  • Diabetes: Diabetes is a group of diseases that affect your ability to process insulin, which results in a dangerous buildup of sugars in the blood. All types of diabetes are considered preexisting conditions. 
  • Lupus: Lupus is an autoimmune disease that causes inflammation in joints, skin, kidneys, blood cells, brain, heart and lungs. 
  • Pregnancy: While it may seem bizarre to consider pregnancy to be a “condition,” short-term health insurance providers classify it as such. If you are pregnant before you enroll in short-term health insurance and still are during the waiting period, your pregnancy is considered a preexisting condition. 
  • Asthma: Asthma is a condition that causes the airways in your lungs to narrow and produce excess mucus at an inappropriate time.
  • Anxiety: If you were diagnosed with anxiety before you enrolled in a health insurance plan, it is considered a preexisting condition. 
  • Depression: Depression, similar to anxiety, is a mental health condition, but it is still considered a preexisting condition.

These are just a few examples of common preexisting conditions. Any health issue or condition that is present when you enroll in a short-term health insurance plan is likely to be classified as a preexisting condition. 

Common Congenital Conditions

Congenital conditions are present since birth, so if you have a congenital condition, there is no avoiding it being considered a preexisting condition. The following are a few of the most common congenital conditions.   

  • Cleft lip or palate: This condition is typically diagnosed during pregnancy. The good news is that children are not denied insurance coverage for preexisting conditions when they are on your ACA-compliant health insurance plan. If detected early, this condition can be corrected when the baby is between 10 and 12 months old in many cases. 
  • Congenital heart disease: Common congenital heart diseases include a hole in the heart, a valve problem or a problem with your blood vessels. 
  • Cerebral palsy: This is a condition that affects body movements. It can be caused by a brain injury, which can occur before, during or after birth. This condition can also be associated with impaired speech, hearing, vision, learning and eating. 
  • Down syndrome: Down syndrome is a genetic condition that can affect a few different parts of the body resulting in developmental and health challenges. 
  • Spina bifida: Spina bifida is one of the more common types of neural tube defects. These types of defects occur during the development of the brain and spinal cord in babies. Spina bifida directly affects the spine and spinal cord. The other type of neural tube defect — anencephaly — affects the development of the brain. 
  • Cystic fibrosis: This is a genetic disease that mostly affects the digestive system and lungs. Cystic fibrosis typically causes continual chest problems and digestive problems. 

Compare Health Insurance

Benzinga offers reviews and insights on the following health insurance providers. You can begin your search for a health insurance plan using the links below. 

  • Blue Cross Blue Shield Health Insurance
    Best For:
    Nationwide coverage
    securely through Blue Cross Blue Shield Health Insurance's website
  • Sidecar Health Access Plan
    Best For:
    No enrollment period health insurance
    securely through Sidecar Health Access Plan's website

    Plans referred to above are excepted benefit fixed indemnity insurance products marketed and administered by Sidecar Health Insurance Solutions, LLC and underwritten by Sirius America Insurance Company or United States Fire Insurance Company, depending on the state. As an excepted benefit plan, it does not provide comprehensive/major medical expenses coverage, minimum essential coverage, or essential health benefits. You cannot receive a subsidy (premium tax credit and/or cost-sharing reduction) under the ACA in connection with your purchase of such an excepted benefit fixed indemnity insurance plan. Also, the termination or loss of this policy does not entitle you to a special enrollment period to purchase a health benefit plan that qualifies as minimum essential coverage outside of an open enrollment period. Coverage and plan options may vary or may not be available in all states.

  • Kaiser Permanente Health Insurance
    Best For:
    Access to Kaiser medical specialists

Frequently Asked Questions

Q

Can I be denied health insurance because of a preexisting condition?

A

No. The Affordable Care Act made it illegal for most insurance providers to deny you coverage because of preexisting conditions. However, short-term health insurance providers do not need to adhere to this rule.

Q

What is considered a preexisting condition for insurance?

A

Any type of health condition that is present before you enroll in a health insurance plan may be considered a preexisting condition, regardless of its severity.

About Sarah Horvath

Sarah is an expert in the insurance, investing for retirement and cryptocurrency space.