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In the United States, receiving medical services comes with outrageous bills that have made many people put their health on the back burner because they are unable to afford it even with health insurance. Having health insurance that is affordable and offers adequate coverage is challenging, even without any pre-existing conditions.

Fortunately, in the past decade, health insurance reforms have alleviated many of these challenges for those looking for health insurance that covers pre-existing conditions. A better understanding of these reforms and conditions can help when searching for the best insurance for pre-existing medical conditions.

Pre-Existing Conditions

A pre-existing medical condition is a health problem that the individual is aware of before applying for health insurance coverage. Pre-existing conditions that a more significant part of the population experience are typically chronic or long-term problems. These conditions include but are not limited to the following:

Insurance Options

You may be wondering if or what pre-existing conditions are not covered by insurance. The answer depends on when you ask this question. Health insurance options for people with pre-existing conditions have changed exponentially within the last decade. Healthcare reforms, precisely the Affordable Care Act (ACA), are to thank for this. While health insurance is still nowhere near perfect, the affordability of and their coverages have been improved, especially for those with pre-existing conditions.


Health insurance companies’ treatment of people with pre-existing conditions before the ACA was more than abysmal, with disadvantages for any health insurance that covers pre-existing conditions. Health insurance applicants would have to disclose, or companies would review their medical history. If there were any pre-existing conditions, companies could excessively charge or flat-out deny coverage to people with pre-existing conditions.

Even those that managed to find health insurance that covers pre-existing conditions would suffer an exclusion period. During this period, they would not receive coverage for care related to a pre-existing condition over a predetermined set of time which could last for months or even more than a year. Any medical services needed during that exclusion period had to be paid out of pocket. As a result, some patients have no choice but to accumulate thousands of dollars in debt. This is a sad situation for all involved because regular care is necessary for many, if not all, pre-existing conditions that can be life-threatening.


Fortunately, the Affordable Care Act was passed, drastically changing health insurance companies’ treatment of those with pre-existing conditions. The ACA established that these companies could no longer deny coverage, enforce exclusion periods, or charge higher premiums because of pre-existing conditions.

This act was monumental for those with pre-existing conditions that needed health insurance. Now, these individuals have the freedom to change jobs, change health insurance, and find affordable plans without the fear of losing coverage or having exclusionary periods enforced on them. Questioning whether or not a plan does or does not cover pre-existing conditions is now a thing of the past.

The ACA set rules that made health insurance that covers pre-existing conditions in the individual and employer-sponsored markets available. Though this did not prevent employer-sponsored plans from having periods of time that must pass before an employee’s coverage went into effect; however, employers could enforce no additional exclusionary periods for pre-existing conditions.

Additionally, if you develop a condition while already enrolled in a policy, your insurer legally cannot increase your rates because of that condition. However, this does not mean that your annual premium cannot or will not increase for other reasons.

Exceptions to the ACA

While the ACA has dramatically benefited people looking for health insurance that covers pre-existing conditions, there are some exemptions to the rules. However, the ACA’s rules on pre-existing conditions do not cover short-term or grandfathered plans. Short-term policies last for at least three months or up to a year, and you can renew them for up to three years. These plans are exempt from being unable to enforce exclusionary periods. So, even if you have pre-existing conditions, apply, and are approved due to the relative shortness of these policies, your treatments do not have to be covered, making these a lousy option.

Grandfathered plans refer to plans put in place before the passing of the ACA. Specifically, any plans established before March 23, 2010, are grandfathered plans. These can be employer-sponsored or union-group health insurance plans, and they are exempt from denying coverage for pre-existing conditions.

Finding the Best Policies

Undoubtedly, the ACA significantly improved the options for finding health insurance that covers pre-existing conditions, but there are more favorable plans depending on individual needs. The best insurance for pre-existing medical conditions is offered on Marketplace – an online resource for individuals that compares health insurance plans.

Those with low enough incomes can qualify for equally good policies through Medicaid and the Children’s Health Insurance Program (CHIP). Also, depending on income, you may be eligible for tax subsidies that reduce premiums. A household’s income must be at least 100% of the federal poverty level (138% or higher in states with expanded Medicaid) to qualify for subsidies.

Gone are the days of choosing a health insurance policy based on whether your pre-existing conditions will be covered, cost more, or make you ineligible. However, it is essential to compare your options and choose the one that best suits your needs. For example, if your conditions require regular medical treatment or care, you should choose a plan with a lower deductible and a higher monthly premium to manage costs better.

At Your Plan Insurance, we know searching for a health insurance plan can be overwhelming, especially for those with stricter needs for pre-existing conditions. We are determined to provide you with plan options that offer comprehensive coverage at affordable prices. Our independent agency status means we represent various insurance companies and are loyal to only your best interests.

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