If you are shopping for a new health insurance plan with a pre-existing condition, you may find that your options have greatly improved. Why? Because of the Affordable Care Act. But what is considered a pre-existing condition, and how have your options changed?

First, what are pre-existing conditions?

Pre-existing conditions are any medical illnesses or conditions you or your dependents had before your health insurance was issued. For example, asthma, high blood pressure, mental illness, and cancer are considered to be ‘pre-existing conditions.’

Pre-existing conditions before the Affordable Care Act

Before the Affordable Care Act was passed, there were generally 2 options for those with pre-existing conditions:

  1. The individual could apply for the same health insurance as a healthy person.
    • The individual with the pre-existing condition may be charged more or denied coverage.
    • Coverage for medical treatments for the pre-existing condition could be denied.
  2. The individual could apply for a Pre-existing Coverage Insurance Plan (PCIP).
    • The PCIP program provided health insurance coverage to individuals with pre-existing conditions.
    • However, you had to be uninsured for at least 6 months and been denied coverage by a private insurance company.

Health insurance coverage for individuals with pre-existing conditions changed once the Affordable Care Act was passed. Not only do individuals have more options, they are also guaranteed minimum essential benefits.

Pre-existing conditions after the Affordable Care Act

Purchasing health insurance with a pre-existing condition:

  • Compare insurance policies online or with a licensed agent
  • Ensure that the policy you choose covers an affordable percentage of your pre-existing condition’s medication and treatment

As of 2014, the Affordable Care Act set strict guidelines for health insurance companies:

  1. Health insurance companies cannot deny coverage to individuals and their dependents with pre-existing conditions.
  2. They have to charge someone with a pre-existing condition the same amount as a healthy person for coverage.
  3. They cannot limit benefits for a pre-existing condition (once you have coverage, the insurer cannot refuse to cover treatment for your pre-existing condition).
  4. Individual health insurance policies must provide coverage for minimum essential benefits.

There is one exemption to the Affordable Care Act’s guidelines for health insurance: grandfathered plans. A grandfathered plan is a health insurance policy that was purchased before March 23, 2010 that hasn’t been altered in certain ways.


Today, even if you have a pre-existing condition, you have an abundance of individual health insurance options. Let HealthMarkets help you navigate your options and find an affordable plan that meets your pre-existing condition’s needs. Get a free quote online, call us 24/7 at (800) 304-3414, or find a licensed health insurance agent near you.



https://www.hhs.gov/healthcare/rights/pre-existing/pre-existing-conditions.html | https://kff.org/health-reform/fact-sheet/obamacare-and-you-if-you-have-a-pre-existing-condition/

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