Pre-Existing Condition
What are Pre-Existing Conditions?
A pre-existing condition is any health problem before enrolling in a health plan. The Affordable Care Act law made it illegal for health plans to or charge more due to a pre-existing condition. This includes Medicare Advantage plans, but not Medicare supplements[mfn referencenumber=1]HHS.gov, “Pre-Existing Condition“, Accessed September 16, 2021[/mfn].
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- Pre-existing conditions are chronic health conditions that exist before enrolling in health insurance.
- The Affordable Care Act law prevents health insurers from denying coverage due to a pre-existing condition.
- Without a guaranteed issue right, Medicare supplement insurance carriers can deny coverage in most states due to pre-existing conditions.
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What Are Some Examples of Pre-Existing Conditions?
A pre-existing condition can be any health condition the beneficiary had before enrolling in Medicare or other health insurance. However, the term is most often associated with chronic or life-long illnesses like cancer, HIV/AIDS, heart disease, high blood pressure, and even mental health conditions such as depression and schizophrenia[mfn referencenumber=2]Cigna.com, “What is a Pre-Existing Condition“, Accessed September 16, 2021[/mfn]. Health issues are considered pre-existing if it was diagnosed by a doctor before the date a beneficiary’s health insurance coverage starts, so there is no real difference between pre-existing medical conditions and existing medical conditions to Medicare[mfn referencenumber=2]Cigna.com, “What is a Pre-Existing Condition“, Accessed September 16, 2021[/mfn].
What is the Affordable Care Act?
The Affordable Care Act (ACA), sometimes also referred to as Obamacare, is a health care reform law that greatly reshaped how health insurance companies like Medicare and Medicaid functioned in order to reduce America’s uninsured population[mfn referencenumber=3]Healthcare.gov, “Affordable Care Act (ACA)“, Accessed September 16, 2021[/mfn]. Among these reforms are guaranteed issue rights, which mandated that people have eligibility for health insurance policies without being denied or charged higher rates due to pre-existing health conditions[mfn referencenumber=4]Healthcare.gov, “Coverage for pre-existing conditions“, Accessed September 16, 2021[/mfn].
Why Can I Be Denied Medigap Coverage?
Medigap (Medicare supplement insurance) can deny certain coverage options for pre-existing conditions because it is not health insurance. It is a form of indemnity insurance that covers the risk of a Medicare beneficiary’s out-of-pocket costs. A Medigap insurance carrier cannot deny coverage when beneficiaries apply for coverage with Medigap protections, also known as guaranteed issue rights[mfn referencenumber=5]Medicare.gov, “When can I buy Medigap“, Accessed September 16, 2021[/mfn].