HealthReform.gov describes a pre-existing condition as a medical problem that occurred before someone applied for a new health-insurance policy. Pre-existing medical conditions affect insurance premiums and the ability of those with medical problems to qualify for insurance. This has a significant impact on access to quality health care.
Types
Examples of pre-existing medical conditions include diabetes, autoimmune diseases, cancer, high blood pressure and heart disease. Some exclusions apply under the Health Insurance Portability and Accountability Act. HIPPA only allows insurance companies to consider the most recent six months of an applicant’s medical history when making eligibility determinations. If medical care for a condition was not received or recommended within that six months, then the insurance company cannot consider the condition a pre-existing condition. Insurers cannot consider pregnancy a pre-existing condition. If you undergo genetic testing, insurance companies cannot use the test results in any coverage decision.
Significance
Insurance companies use information on pre-existing conditions to charge high premiums or deny coverage to applicants with serious conditions. This makes it difficult for those with chronic illnesses and disabilities to obtain and maintain continuous health-insurance coverage. Without steady coverage, people with medical problems cannot get the care they need to prevent complications.
Statistics
The problem of pre-existing conditions is not limited to a specific age group. The Families USA Foundation reports that 15.9 percent of adults ages 18 to 24 have a pre-existing medical condition. Families USA also reports that 5 million children have a pre-existing medical condition. In terms of race and economic status, lower-income families and those of American Indian descent are the most likely to have pre-existing conditions that lead to the denial of health-insurance coverage.
High-Risk Pools
Some states have high-risk pools for people who cannot get health insurance. Unfortunately, HealthReform.gov reports that these high-risk pools charge higher premiums to those with pre-existing conditions than they charge to healthy people. Other problems with high-risk pools include limited eligibility and annual caps on the number of people who can enroll in the plans.
Alternatives
For those who cannot obtain traditional insurance coverage due to pre-existing conditions, state and federal medical programs and catastrophic medical plans provide some coverage. Medicaid offers health coverage to low-income families and those who have disabilities or high medical bills. The requirements vary by state, but each state considers income and resources when making an eligibility determination. In New York, for example, the 2010 monthly income limit for singles and couples without children is $707, according to the New York State Department of Health. Pregnant woman have a higher income limit of $903 per month.
Catastrophic health plans, also known as high-deductible health plans, have high deductibles and lower monthly premiums. A deductible is the amount of money a plan participant must pay for medical expenses before the insurance company starts paying. These health plans do not offer comprehensive medical coverage, but provide some measure of coverage for emergencies and hospitalizations.
References
- HealthReform.gov: Coverage Denied: How the Current Health Insurance System Leaves Millions Behind
- United States Department of Labor: FAQs About Portability of Health Coverage and HIPAA
- Families USA Foundation: Health Reform: Help for People With Pre=Existing Conditions
- New York State Department of Health: Medicaid in New York State
- The Washington Post: High-Deductible Health Insurance Plans Grow More Attractive to Employers
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