03 May 2017

What is a Pre-existing Condition?

What is a Pre-existing Condition?

In the health insurance industry, a pre-existing condition is an illness, disease, or other ailment that started before a person’s health insurance policy comes into effect. This includes cancer, HIV/AIDS, in addition to diabetes and other chronic conditions.

Before 2014, some insurance companies didn’t cover pre-existing conditions. This meant that people who were seeking treatment for illnesses or were being treated for certain conditions may not have been able to renew or purchase a new insurance policy in order to take advantage of better rates.

However, since the Affordable Care Act came into effect, insurance companies involved in the state and federal insurance marketplace are required to offer insurance to individuals with pre-existing conditions. This increases the number of people who are involved in the insurance marketplace and who are mitigating the insurance risk over a greater pool of policyholders.

Pre-existing conditions under Trump

Although a lot of the details are not known, there are likely to be some changes to the health insurance structure in the United States under Trump. The Affordable Care Act is still the law of the land, which means people with pre-existing conditions will still be offered affordable insurance policies without discrimination.

Trump has stated that he will keep the pre-existing conditions clause the same under his health insurance plan. People will still be able to get health insurance if they have a pre-existing condition. However, there is some question as to whether or not people with pre-existing conditions will have to pay higher insurance premiums in order to get the insurance they want and need.

Unfortunately, there is no concrete health care plan that has been put forward detailing the health insurance coverage options under Trump, so it is uncertain as to what the actual details of the health care plan will do to change the existing insurance structure in the United States.

Pre-existing conditions

There are two standard definitions for pre-existing medical conditions. One is a disease or illness that a person received treatment for before their health insurance came into effect, and the other is a condition that existed prior to the insurance policy that should have received treatment.

Pre-existing condition exclusions were formerly regulated by each individual state. Under the Affordable Care Act, non-group and group insurance policies were unable to refuse insurance policies to anyone with a pre-existing illness.

The benefits of pre-existing conditions clauses

There are a number of benefits that come from offering health insurance to people with pre-existing conditions. Offering insurance to everyone increases the number of people who are paying into the health insurance marketplace. This spreads the insurance risk over a larger number of people so that premiums are regulated and more people are able to afford insurance.

Making health insurance available to people with pre-existing conditions also ensures that they are able to receive care. People who can receive health insurance are able to receive the medical care they need and be supported by their insurance agency and medical professionals so that they can focus on improving their quality of life.

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