Pre-Existing Condition in Health Insurance Sector

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Many Americans might have health issues like high blood pressure, common allergies, cancer, type 2 diabetes, or any other chronic health problems that affect a large number of people. These medical conditions are defined by the insurance companies as pre-existing conditions. If you have any of these medical conditions before enrolling in a health plan, then it proves as an obstacle for you to have health insurance. Health insurance companies operating for their financial benefit do not find beneficial to include individuals with pre-existing conditions.

Even if the health insurance companies provide coverage to such individuals, they either impose a waiting period, charge higher premiums, or charge higher out-of-pocket expenses because they are likely to cost more in terms of claim expenses. Such provisions make it harder for people to obtain health coverage, so several states and federal governments regulated this issue in the insurance market. Thanks to the Affordable Care Act that changed the health insurance market, and allowed individuals with pre-existing conditions to obtain health coverage. Before the Affordable Care Act, the pre-existing medical condition was a big deal and hindrance to obtaining health coverage.

In most of the states before the Affordable Care Act, insurance companies used medical underwriting to determine the applicant’s premium and eligibility for coverage. Based on these underwritings, insurance carriers can refuse to sell health plans to individuals if they have a pre-existing condition. The Affordable Care Act kicked in 2014 due to which health insurers in the United States cannot consider your health history when deciding to offer you a comprehensive health insurance plan. Health insurance carriers cannot exclude a pre-existing condition from coverage nor they can charge extra for a pre-existing condition. Therefore, this has further made it easier for people with pre-existing conditions to buy individual health insurance.

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All the ACA compliant health insurance plans available on the health insurance exchanges are guaranteed issue. It means, the health insurance companies cannot refuse you to offer health insurance coverage, if you are applying for it during the open enrollment period or a special enrollment period. It is also applicable for all major individual health plans, that are sold outside the exchange if the plans are ACA-compliant.

President Trump and some prominent lawmakers are expressing a desire to repeal the ACA, and are still working on the details of a replacement plan. Eliminating pre-existing condition is not at all a wise decision, as this protection tend to be the most popular ACA provisions. However, this has led to an increase in the premiums in the individual market. Some Americans like to see less robust protection for people with a pre-existing condition, in trade to reduce premiums amount. However currently, all the ACA’s consumer protections are in place as long as people shop for the ACA-complaint plans.

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