Does my Health Insurance cover Pre-existing Conditions?

This is an important question to consider in the changing landscape of health insurance.


Before we go any further, let’s define pre-existing conditions, give some examples, and explore why it even matters.

A pre-existing condition is defined as: A medical condition that began before a person’s health benefits went into effect.

A real-life example might be someone that has type 2 diabetes.  If this person had an insurance plan that does not cover pre-existing conditions, none of their insulin or medications would be covered, nor would any health complications that came about as a result of the diabetes.  This includes neuropathy, retinopathy, and a host of other circulatory and nerve issues.  However, if this person was diagnosed with diabetes AFTER their health insurance policy goes into effect, the diabetes would not be considered pre-existing, and they are going to be covered for everything associated with it.  This would be the case for someone that has cancer or any other major or minor illness.

One area of question is for minor things such as high-blood pressure or high-cholesterol that is controlled with medication.

For people with high blood pressure or high cholesterol, some health insurance plans do not extend this to other circulatory issues.  This is important to find out before purchasing your policy if you take a circulatory system medication of some sort.  One company we work with will cover the person for heart attacks, strokes, and other circulatory events – even if the person takes a high blood pressure medication.  However, the blood pressure medication would not be covered, nor would doctor visits or procedures specifically to address the high blood pressure.

Health plans that cover pre-existing conditions

If you have an “ACA compatible” plan, rest assured that your pre-existing conditions are covered.  However, many other plans do not cover these pre-existing conditions.

Plans for individuals that are ACA compatible can be purchased on the government-sponsored health insurance exchange websites.  These plans are unbelievably expensive for people that don’t receive financial assistance from the government.  The prices for these people are strictly based on their age.  A basic plan in Kansas City, MO that costs $347/month for a 22-year-old, costs a whopping $1,078/month for a 63-year-old.  This is a big reason why healthy individuals (without any major pre-existing conditions) have been shopping around for cheaper options, even if pre-existing conditions aren’t covered.

Most employer /group health plans are ACA compatible and cover all pre-existing conditions.  Contact us to ask about your specific situation.

Article continues below…

Contact us for more information

Health plans that do not cover pre-existing conditions

If a plan isn’t “ACA compatible” chances are it does not cover pre-existing conditions.  However, this does not mean it is a bad option for most people.  It is often a very good option for people that don’t have any pre-existing conditions.

The two most popular alternative plans that don’t cover pre-existing conditions are Short-Term-Health plans and religious entity “Medical Sharing” plans.  These can be attractive options for people that don’t receive a tax-credit to assist with premiums for ACA-compatible “Obamacare” plans.  Let’s look at each one individually:

Short-Term health plans

Short-term health plans can be up to 364 days in length in most states and are our recommendation of choice for people without pre-existing conditions.  In most situations, RXs and Maternity are not covered under Short Term Health plans.  A simple way to remember what’s not covered on short-term health plans to is to think of “three P’s”:  pre-existing conditions, prescriptions, and pregnancy.  For people that don’t need these covered, short-term health plans are relatively cheap.  For a 63-year-old in Kansas City, MO, a Short Term health plan with a $5000 deductible would be $377/month or less.  Compare this to an ACA compatible plan on the health insurance exchange with a $7900 deductible at over $1,000/month.

“Medical Sharing” religious sharing plans

The religious entity medical sharing plans are NOT insurance.  These plans are not regulated by law like insurance, and thus, are not required to pay anything for your medical services!  We have heard many stories from people who have tried these plans, and the things they thought would be covered were not.  Because of this, we recommend Short Term Health plans over the religious Medical-Sharing plans, when considering options that don’t cover pre-existing conditions.

Categories: Health Insurance