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  • A pre-existing condition is a health condition that you have prior to attempting to acquire health insurance
  • Previously, health insurance companies would refuse applicants if they had certain pre-existing conditions
  • People suffering from pre-existing conditions may be eligible for gap insurance coverage


A pre-existing condition is a health condition that you have prior to attempting to acquire health insurance. This may include treatable conditions  such as diabetes or terminal diseases such as cancer.

Many companies refused for years to allow people with pre-existing conditions to get healthcare coverage. However, recent changes in the law and insurance practices have made it easier for those with pre-existing conditions to get coverage.

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Can I be insured?

adobestock_103283914-1600x1600-1Traditionally, people with pre-existing conditions were defined as health problems that were costly to treat. These people were either denied coverage or were made to wait a certain period before coverage could begin.

Premiums and out-of-pocket costs were often higher with these plans as well.

Having a pre-existing condition does not necessarily mean that you cannot get any health coverage at all.

Many companies have an exclusion policy, which means that you can receive treatment during the waiting period for any condition not related to the pre-existing condition.

Once the waiting period has expired, you can also receive coverage for treatment related to your pre-existing condition.

What are the risks to changing health insurance companies with a pre-existing condition?

Some health insurance companies consider common ailments such as high blood pressure, type-2 diabetes, and low-risk cancers as pre-existing conditions.

This means that thousands of people are in danger of losing their health insurance coverage if they change jobs, move, or have some other event in their lives that causes them to change providers.

For those with lower income levels, having to pay full price for medications and treatment can be a huge financial blow. For this reason, some people with pre-existing conditions end up uninsured.

GAP Coverage for People with Pre-Existing Conditions


In an effort to stem this growing problem, the Department of Health and Human Services announced in 2010 that it would provide gap coverage for those with pre-existing conditions who had been denied health insurance coverage.

The Pre-existing Condition Insurance Plan would cover those who had been uninsured six months or more, had been denied coverage by an insurance plan, and were U.S. residents or legal aliens.

Premiums average between $140 and $900 per month depending on age and income. The program is administered in some states by the federal government; in others, it is administered by the states themselves.

In order to find out if you qualify for this coverage, visit the Department of Health and Human Service’s website (www.hhs.gov) for more information and to find your local office.

How much does it cost per month?

The Pre-existing Condition Insurance Plan is part of the larger initiative known as The Patient Protection and Affordable Care Act signed into law in 2010 and scheduled to be fully implemented by 2014.

Known as The Healthcare Act, it has been debated fiercely by both citizens and insurance carriers. Many feel it is overreaching, while many others hail it as the end to uninsured citizens in the United States.

The provisions of the Healthcare Act state that by 2014, no insurer can deny coverage based on a pre-existing condition. Until such time, the gap coverage provided by the Pre-existing Condition Plan will pay for those who have previously been unable to obtain health insurance

The debate over this issue springs from a feasibility question. If health insurance companies are forced to pay for claims by those with high-risk diseases, premiums for everyone will go up significantly. For those without serious illnesses, especially those with healthy lifestyles, this may seem unfair.

After all, many diseases are caused by lifestyle choices: smoking causes lung cancer and emphysema, poor diet and exercise habits contribute to type II diabetes, and many forms of cancer are induced by environmental causes.

On the other hand, proponents argue that failing to insure these patients simply inflates the already overburdened public health system, as these people will most likely be facing personal bankruptcy eventually from medical bills.

The supporters of the Healthcare Act argue that by paying more in premiums early on, the taxpayers are saving money in the long run.

No matter which side of the question you are on, everyone agrees that non-insured people face a very big problem. Finding affordable healthcare options for those with pre-existing conditions may well become easier in the next few years; whether they will be more affordable remains to be seen.

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[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

  1. http://health.howstuffworks.com/health-insurance/exclusion.htm
  2. http://obamacarefacts.com/2016/04/07/drug-prices-and-the-cost-of-healthcare/
  3. http://obamacarefacts.com/insurance-exchange/short-term-health-insurance/
  4. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Insurance-Programs/Pre-Existing-Condition-Insurance-Plan.html
  5. https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
  6. https://en.wikipedia.org/wiki/Health_insurance
  7. http://www.hhs.gov/healthcare/about-the-law/