Private Health Insurance for Pre-Existing Conditions

Applying for private health insurance with pre-existing conditions could seem intimidating, but it shouldn’t. All insurers on the Marketplace are legally required to cover treatment for pre-existing medical conditions. Now, some companies are tailored to your needs.

Keep reading to learn more about pre-existing conditions, how they are diagnosed, and which private health insurance plans are right for you. There may be some difficulties when it comes to navigating certain processes with a pre-existing condition, but finding affordable health insurance is not one of them.

If you’re ready to speak with someone in your area about rates for private health insurance for pre-existing conditions, use our free comparison tool above to start comparing private health insurance quotes today. 

Read more: Can I get life insurance with a pre-existing condition?

Examples of Pre-Existing Conditions for Health Insurance

Before we dive into this private health insurance pre-existing conditions tips and tricks guide, let’s talk about the phrase “pre-existing condition.” 

It’s a term used in the healthcare industry that once meant “exclusion.” In 2014, those with ailments and diagnoses may have been forced to enroll in the federal Pre-existing Condition Insurance Plan (PCIP). Since the full rollout of the ACA, the PCIP has been dissolved, and private insurers are prohibited from refusing applicants coverage for their pre-existing conditions.

As defined in the Affordable Care Act (ACA), a pre-existing condition is a health problem that started before the date of a new health insurance policy.

It is a condition that you either report or your health insurance provider sees in your medical record during the application process. Medical records are not always required since you cannot be denied due to a pre-existing condition.

Pregnancy, for example, could be a temporary form of a pre-existing condition. Other common conditions are:

• Arthritis
• Asthma
• High cholesterol
• Hypertension
• Obesity
• Cancer
• AIDS/HIV
• Alcohol and drug abuse
• Kidney disease
• Mental disorders
• Lupus

Sometimes, conditions that are as far back as 10 years on your medical record could qualify as “pre-existing.”

Though private health insurance cannot be impacted by your health, companies sometimes can wiggle around the rules. Keep reading to learn more about the private health insurance definition of bending — not breaking — the rules.

Read more: How To Get Life Insurance With Lupus

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How to Get Private Health Insurance for Pre-Existing Conditions

All U.S. citizens can buy health insurance on the Health Insurance Marketplace created by the Affordable Care Act.

The Affordable Care Act (ACA) was a healthcare overhaul enacted by Congress on March 23, 2010, with the goal of ensuring anyone could buy health insurance. As a result, health insurance companies on the Marketplace could no longer avoid providing coverage to those with pre-existing conditions. The act also eliminated waiting periods that required those with pre-existing conditions to remain on employer-sponsored plans.

You need to create a Marketplace account during the enrollment period to shop and buy health insurance plans. However, some loopholes may impact acquiring coverage. Keep reading to learn more.

When You Might be Denied Health Insurance with a Pre-Existing Condition

While no one can be denied a health insurance policy that the ACA regulates, there are specific policies and circumstances where an insurer could deny coverage to someone with a pre-existing condition.

Grandfathered plans, health insurance policies that the ACA doesn’t regulate, and group plans are the three coverage types that may still deny you if you health insurance for a pre-existing condition.

Suppose you’re offered a private health insurance quote reflecting your pre-existing condition. In that case, you may be looking at a short-term medical plan, often referred to as temporary health insurance. This type of plan usually ends within a year and provides coverage for certain services, such as routine office visits, preventive care, and prescription drugs. The other non-regulated health plan is a fixed indemnity plan. 

If you don’t need to buy private health insurance, you may have been assessed based on your medical history. Any policy that was purchased before March 23, 2010, is grandfathered in and does not need to abide by the pre-existing condition rule of the ACA.

The final category that is allowed to prohibit coverage is insurers in the large group market. This means any group — generally an employer of some kind — can use the collective medical history to determine the price of coverage. However, it’s more common for large groups to contract with an insurance company for individual health coverage.

Keep reading to learn more about which private health insurance companies are the most affordable and accessible to those with medical conditions. 

How Pre-Existing Conditions Affect Health Insurance Costs

The fear of having a pre-existing condition and applying for health insurance is more than likely associated with cost. If you have a condition requiring regular doctor visits or expensive medicine, you may want to look for an insurance company that offers more than just the basic policy. 

Some companies offer plans with low deductibles without gouging for premiums. Others offer catastrophic coverage for when your primary plan isn’t covering your medical bills. 

See the table below for some terms to be aware of as insurance providers rank your risk: 

Health Insurance Classifications

Class	Personal Health	Family History
Preferred	Nonsmokers in great health with a minor condition	Minor health conditions in family history
Preferred Select	Nonsmokers in great health	No family history of health conditions
Preferred Smoker	Smokers in great health	No family history of medical conditions
Standard	Nonsmokers with average health	Some medical problems in family history
Standard Plus	Nonsmokers in good health with a few minor health conditions	Minor conditions in family history
Standard Smoker	Smokers in good health	Some medical conditions in family history
Table Rating	Poor health	Medical conditions in family history

Remember that you are not required to purchase private health insurance with a pre-existing condition. You can also receive Medicare benefits. See which one is right for you. ( For more information, read our “Private Health Insurance vs. Medicare: Which Is Better for You?“).

Case Studies: Private Health Insurance for Pre-Existing Conditions

Case Study 1: John’s Diabetes Coverage

John, a 45-year-old individual, has been living with diabetes for the past 10 years. He was concerned about obtaining private health insurance due to his pre-existing condition.

However, after exploring the options available on the Health Insurance Marketplace, he discovered that all insurers regulated by the Affordable Care Act (ACA) are required to cover treatment for pre-existing conditions.

John was able to find an affordable health insurance plan that provided comprehensive coverage for his diabetes management, including medication, doctor visits, and specialized care.

Case Study 2: Sarah’s Asthma Treatment

Sarah, a 32-year-old woman, has been managing asthma since childhood. She was worried about the costs associated with her condition and the possibility of being denied coverage. However, Sarah learned that under the ACA, private health insurance companies cannot refuse coverage based on pre-existing conditions.

She explored different plans on the Marketplace and found an insurance company that offered specific coverage for asthma-related treatments and medications. Sarah was able to secure a policy that suited her needs and ensured she received the necessary care for her condition. (For more information, read our “How To Get Insurance With Asthma“).

Case Study 3: Michael’s Hypertension Care

Michael, a 58-year-old man, was diagnosed with hypertension several years ago. He needed private health insurance that would cover his ongoing treatment and regular doctor visits. Despite his pre-existing condition, Michael discovered that there are numerous insurance options available for individuals with hypertension.

He compared quotes from different insurers and found a plan with reasonable premiums and comprehensive coverage for hypertension management. Michael now has peace of mind knowing that his health insurance adequately supports his needs.

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Private Health Insurance for Pre-Existing Conditions: The Bottom Line

Now that you know the rules, applying for private health insurance with pre-existing conditions does not have to be intimidating. All insurers regulated by the ACA are required to provide affordable health insurance to everyone — even those with pre-existing conditions.

Some companies may better serve your medical needs than others. When you’re ready to speak with someone in your area about quotes for private health insurance with pre-existing conditions. Use our free tool above to start comparing private health insurance quotes.

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