Health insurance is a very important safety measure against any unexpected expenses related to our health. At the same time, the world of health insurance can be tricky to navigate, especially in the case of a pre-existing condition. Any health problem that you might have had before enrolling for insurance coverage may be considered a pre-existing condition. These could have implications for your eligibility, what is covered, and how much premium you will pay. We’re going to discuss in this article how pre-existing conditions influence health insurance and what you can do to make sure that you are well protected.

Understanding pre-existing conditions

Before talking about the effect of pre-existing conditions on health insurance, let us define what they are. A pre-existing condition refers to any illness, injury, or chronic disease that was there before your new health insurance policy. Common examples include diabetes, asthma, heart disease, and cancer. This used to be termed high-risk by insurance companies, leading to expensive premiums or just plain denial of coverage.

Premiums: Probably the most important way pre-existing conditions impact health insurance is through premium costs. The health status determines the amount of risk associated with the person the insurance company will be covering. If you have a pre-existing condition, that means you could be considered by the insurer as more likely to require medical care. Therefore, higher premiums should be charged to offset the possible costs. However, recent regulatory changes, for example, the ACA in the US, have significantly reduced this premium increase by insurers due to a pre-existing condition alone.

Limitation to Coverage

The second problem faced by individuals with pre-existing conditions is the limitation of coverage. Previously, insurers could exclude coverage for specific treatments related to a pre-existing condition. For example, if you had diabetes, your insurance may not have paid for insulin or other therapies associated with it. It’s been quite a problem for many individuals to get adequate care. Fortunately, under acts like the ACA, insurers are no longer allowed to decline coverage for pre-existing conditions, so clients are able to obtain appropriate medical care.

Waiting Periods

While some insurers simply deny coverage in relation to pre-existing conditions, others have a waiting period. This waiting period is a period of time that you may need to wait before your insurance covers treatments relating to your pre-existing condition. It really depends on the insurer and the policy in question; this can vary from some months down to a maximum period of one year. During this time, you will pay out-of-pocket for all treatments pertaining to that illness. However, some policies, especially those offered by an employer, might not include such waiting periods.

The Role of Health Insurance Regulations

It is, therefore, very important to protect those with pre-existing conditions through health insurance regulations. For instance, the ACA prohibited insurers from either denying coverage or exorbitant premium pricing due to health status. The ACA further had an addition: “guaranteed issue.” It entailed that the insurers were obligated to extend coverage to everyone, irrespective of any pre-existing conditions. As such, millions of people are now aware of the fact that they can get health insurance without discrimination.

Alternatives and options

In the case of a pre-existing condition, you need to look at all your options carefully while selecting health insurance. Generally, employer-sponsored health insurance is good because, most of the time, these plans cover pre-existing conditions without waiting periods, although the premiums may be higher. Government programs also allow many people—for example, those eligible for Medicaid or Medicare—to obtain coverage irrespective of pre-existing conditions. If you’re buying insurance on your own, you may want to seek the help of a licensed insurance broker who can assist in finding the right plan for you.

How Much Can You Lower Your Premiums?

Even if you have a pre-existing condition, there are ways in which you may be able to lower your health insurance premiums. One such strategy is to choose a higher deductible. A deductible refers to the amount that you pay out of pocket before your insurance kicks in to cover costs. You can probably reduce the amount of your monthly premium by opting for a high deductible. Beyond that, maintaining a healthy lifestyle helps in controlling and preventing your condition from getting worse, which again would keep the cost of your health care low.

Final Thoughts

Health insurance is very vital for various reasons, especially if one has a pre-existing condition. While pre-existing conditions can affect your insurance, knowing the laws and options available will help to a great extent in getting you the necessary coverage. Keep yourself informed, ask questions, and make a very well-reasoned decision about your health and financial well-being.