Pre-Existing Conditions

Finding and signing up for the right health insurance plan is confusing enough. Add to that the guesswork of figuring out what ‘pre-existing conditions' you may have that insurers will look at to decide whether to deny you, charge you more than your neighbor, or eliminate specific benefits you need, and the process becomes dizzying and even frightening.

Pre-existing conditions are health problems that individuals already had when they purchased coverage. In the majority of states, insurers do not have to offer you a policy at all if you have a pre-existing condition. If they do, they can price your premium infinitely higher than premiums for healthy people, and they can exclude coverage for the very health problems you sought coverage for. Furthermore, insurers may treat something as benign and unavoidable as below-average height as a pre-existing condition. And insurers also can deny you coverage or charge you more simply because your family has a history of medical problems. Very few restrictions exist in state law to curtail these discriminatory practices.

Fast facts about pre-existing conditions:

• Only five states require insurers to sell all plans to all people-stopping insurers from cherry-picking the healthiest among us and leaving those with pre-existing conditions out in the cold.
• 21 percent of adults seeking coverage on the individual market were turned down, charged a higher price, or offered a plan that excluded a specific health problem.
• 33 percent of adults with a health condition seeking coverage on the individual market were turned down, charged a higher price, or offered a plan that excluded a specific health problem.
• In twenty-one states and the District of Columbia, individual insurers can exclude coverage of a pre-existing condition for more than one year.
• In twenty-five states and the District of Columbia, individual insurers can dig through more than a year of your medical history to decide if you have a pre-existing condition.
• In thirty-eight states, insurers can offer an insurance policy that explicitly excludes a particular condition for as long as the individual keeps it.
• In thirty-two states and the District of Columbia, insurers are not limited to examining ‘pre-existing conditions' that a health care provider diagnosed. In those states, insurers can allege that, based on symptoms, an individual unknowingly has a condition that is grounds for denial, a higher premium, or exclusion from coverage, regardless of the medical opinion of the individual's doctor (as reflected in medical records).
• Six out of 10 adult Americans has at least one chronic medical condition.
• Nearly four out of 10 Americans between 18 and 34 years of age has at least one chronic condition.
• Tens of millions of Americans receive medical treatment for one or more chronic condition each year including:
  
  • 45 million people with high blood pressure
  • 49 million people with asthma or chronic obstructive pulmonary disease
  • 22 million people with osteoarthritis and related conditions
  • 19 million people with heart disease
  • 17 million diabetics