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June 15, 2019

Can I Be Denied Health Insurance Because of a Pre-existing Condition?

Can I Be Denied Health Insurance Because of a Pre-existing Condition?

Wondering if you can be denied health insurance because of a pre-existing condition? Here’s a quick rundown.

Primary Health Insurance

When it comes to your primary health insurance, the answer is no. According to the US Department of Health and Human Services, “Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a ‘pre-existing condition’ — that is, a health problem you had before the date that new health coverage starts.” This law applies to plan years starting on or after January 1, 2014 (the one exception is grandfathered plans purchased on or before March 23, 2010)1. For more information about this law, visit hhs.gov. To know your health insurance options, visit HealthCare.gov.

Medigap Insurance

What if you have a pre-existing condition and want to purchase a Medigap policy? According to Medicare.gov, “even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.” However, if you want to purchase a Medigap policy outside your open enrollment period, the insurance company can sometimes refuse to cover out-of-pocket costs you may have for treatment for your pre-existing conditions for up to six months; after that period, “the Medigap policy will cover your pre-existing condition”2. For more information about Medigap policies and pre-existing conditions, visit Medicare.gov.

Supplemental Health Insurance

Let’s say you have a pre-existing condition and you want to know if you can purchase supplemental health insurance. According to verywellhealth.com, the Affordable Care Act does not regulate supplemental health insurance, which means that “an insurer can deny coverage based on your medical history, impose limits on pre-existing conditions, and cap benefits at fairly low levels”3. And while you can purchase a supplemental plan whenever you’d like (unlike primary insurance which is purchased during an open enrollment period), “many plans do exclude pre-existing conditions,” according to healthmarkets.com4. If you have a pre-existing condition and would like to know your supplemental health insurance options, contact an independent broker or a licensed insurance agent.

If you have any questions about your health insurance, contact a health insurance expert.

  1. “Pre-Existing Conditions,” US Department of Health and Human Services,

  2. “When can I buy Medigap?” Medicare.gov

  3. “Should you buy supplemental health insurance?” VeryWellHealth,

  4. “Supplemental Health Insurance 101,” HealthMarkets.com,

Categories: Insurance, Supplement Health Insurance

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