What's a Pre-Existing Condition?

Switching to a new health insurance plan can be confusing, especially if you have pre-existing health conditions.

You might wonder what qualifies as a pre-existing condition and whether it will affect future coverage. Here, we break it all down to help you prepare for new coverage.

What Does ‘Pre-Existing Condition’ Mean When It Comes to Health Insurance?

A pre-existing condition is any health problem you already had before your new health insurance coverage begins. In most cases, you've likely already been diagnosed with the condition and are receiving treatments. However, if you know about the condition and haven't sought out medical care yet, it could still be considered a pre-existing condition since you're aware of it. An example would be pregnancy, even if you haven't visited a doctor yet.

Talk to a Pro

What Qualifies as a Pre-Existing Condition?

Pre-existing conditions include nearly any health situation you have before your plan starts, including diseases, illnesses, injuries and other conditions. Chronic health conditions are often the things that come to mind with pre-existing conditions, since the treatment is ongoing and potentially costly. This can include conditioners such as cancer, epilepsy, asthma, heart disease and diabetes. Pregnancy can be considered a pre-existing condition if you're already pregnant when you move to a new health insurance plan.

Can a Health Insurance Company Refuse to Cover a Pre-Existing Condition?

In the past, health insurance companies could deny you coverage or charge a lot more based on your pre-existing conditions. Some insurance companies would refuse to cover pre-existing conditions for a certain amount of time after your policy started. This left many people without coverage or forced them to pay for expensive treatments for chronic conditions out of pocket.

However, the Affordable Care Act, passed in 2010, prevents health insurance companies from doing those things. They have to offer you coverage, and they can't increase your rates based on your pre-existing conditions. Insurance companies also can't limit your coverage or refuse to pay for treatments associated with your pre-existing conditions once you start the policy.