Can Health Insurance Be Denied for a Pre-Existing Condition?

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Can Health Insurance Be Denied for a Pre-Existing Condition?

Under the Affordable Care Act, beginning in 2014, insurance companies will not be able to deny coverage to individuals who have pre-existing health conditions.

What Is a Pre-existing Medical Condition?

Prior to recent health care reforms, many individuals had trouble obtaining health insurance if they had pre-existing medical conditions. Insurance companies could refuse, cancel, or alter coverage for individuals suffering from pre-existing medical conditions including:

When Does the Affordable Care Act Become Effective?

As to children (less then 19 years of age), prohibition on denial of coverage based on preexisting medical conditions became effective in 2010. For such children, the consequences are the following:

The Affordable Care Act provision on preexisting medical conditions will start covering everyone, not just children, in 2014.

Pre-existing Medical Condition Exception: Grandfathered Plans

A "grandfathered" insurance plan is a group health plan created or purchased on or before March 23, 2010. Many provision of Affordable Care Act does not apply to such grandfathered plans currently owned by insured individuals. As a result such plans are still not required to cover pre-existing conditions.

What to Do If You Have a Grandfathered Insurance Plan?

If many of the Affordable Care Act provisions do not apply to your insurance plan, you may elect to switch to the insurance plan sold at special exchanges during the enrollment period. That way your preexisting medical conditions will be covered as required by the Affordable Care Act.

Open enrolment ends March 31, 2014. For 2015 coverage, open enrollment period begins November 15, 2014. Note that one may still get insurance coverage through a special system of exchanges (also know as "health insurance marketplace") outside of enrollment the period provided that there is a qualifying life event, such as: moving to another state, changes in income level, or changes in family size.

Seeking Help from an Attorney

An attorney can provide assistance if you believe that there is a mistake in your health insurance coverage. If you are not adequately covered or have been wrongfully denied coverage, you should consult a qualified health insurance lawyer.

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Last Modified: 01-27-2017 12:11 PM PST

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