How To Ensure Pre-Existing Conditions Are Covered

What Is A Pre-Existing Condition?

A pre-existing condition is where you sought medical help before obtaining your health insurance. In other words, the condition existed before your health insurance plan coverage did.

Many times, pre-existing conditions refer to chronic medical or mental health conditions. For example, diabetes, high blood pressure, cancer, and depression.

Accidents or illnesses could also result in having a pre-existing condition. For example, pregnancy was frequently considered a pre-existing condition if the pregnancy occurred before enrolling in the health insurance plan. 

Before the Affordable Care Act, many people with chronic conditions found it very difficult to get health insurance coverage. The exception was employer health insurance programs that included treatment for their medical issues.

Entrepreneurs who are self-employed, small businesses, independent contractors, and freelancers risked complications from chronic health conditions because it was almost impossible to find health insurance plans outside of traditional employer health insurance that covered chronic and pre-existing conditions. As a result, people were forced to weigh up being entrepreneurs versus having adequate health coverage through an employer.

New Rules about Pre-Existing Conditions

From January 1, 2014, it became illegal to deny you or a family member health insurance coverage due to a pre-existing condition. Health conditions like diabetes, cancer, and asthma can no longer be denied. Insurance providers also can no longer limit any benefits for pre-existing conditions, and they also can’t increase rates because of pre-existing conditions.

Once you enroll in a health insurance North Carolina plan, you now have the comfort of knowing your chronic condition is covered, even if you lose your job. This provides much-needed peace of mind for people all throughout the US, including North Carolina. In addition, it can help to reduce the stress and fear of living without medical coverage, particularly during times of economic uncertainty. 

All about Pregnancy Coverage

Under the Affordable Care Act, health insurance plans must also provide pregnancy care. Before the ACA, most health insurance plans considered pregnancy and childbirth a pre-existing condition if the pregnancy occurred before arranging insurance.  Most did not cover pregnancy at all without paying an extra premium for a maternity rider on their health insurance plan.

Pregnancy coverage now begins when a health insurance plan starts. A health insurance plan can’t refuse coverage because of pregnancy, even if you were pregnant before the plan’s coverage began. Complete coverage for pregnancy and childbirth starts as soon as the plan does.

If you’re currently enrolled in a health insurance plan and adopt a child or give birth, you’re eligible for a Special Enrollment Period. This allows you to select another health insurance provider or change health plans outside the Open Enrollment Period. You have 60 days from the date of the birth or adoption to change plans, and coverage eligibility begins from the date of birth or adoption

There are some individual health insurance plans that do not cover pre-existing conditions. These plans are “grandfathered” in and do not have to comply with the regulations regarding pre-existing conditions.

Grandfathered Insurance Plans and Pre-Existing Conditions

It’s essential to realize some individual health insurance plans don’t cover pre-existing conditions. These plans are ‘grandfathered’ and don’t have to comply with the regulations regarding pre-existing conditions.

A health insurance policy in effect on or before March 23, 2010, that has not reduced benefits or increased in price may qualify for the grandfathered status. For example, suppose you’re added as a new employee to a group health insurance policy that has been grandfathered. In that case, the pre-existing condition coverage rules may not apply.

You won’t have a grandfathered health insurance plan if you purchased an individual health insurance policy after 2013. The grandfathered exclusion applies to employer-provided plans and a small number of individual plans. Grandfathered plans, which were already in force as of March 23, 2010, can continue to remain in force indefinitely, at the discretion of the health insurance carrier as long as they don’t make any substantial changes to the coverage. Check with your health insurance provider if you’re concerned your plan may fall into the grandfathered category.

What If You Have A Grandfathered Insurance Plan?

If you discover your health insurance plan does fall into the grandfathered category and you’re not covered for pre-existing conditions, you may also be unable to access preventative care. If you want to switch to coverage that provides preventative care and allows pre-existing conditions, you can:

1. Wait for the annual Open Enrollment Period and switch to a Health Insurance Marketplace Plan that offers coverage for pre-existing conditions.

2. Purchase a Marketplace health insurance plan when your grandfathered plan year ends. You’ll qualify for a Special Enrollment Period and can purchase a more suitable plan for you.

Preventative Care Through Healthcare Marketplace Plans

Unlike grandfathered health plans, Health Insurance Marketplace Insurance Plans cover pre-existing conditions and provide preventative care. Preventative care is a significant benefit covering a wide range of services. Some examples include: 

• Immunizations

• Birth Control

• Well baby and well child visits

• Breastfeeding support

• Cholesterol screening

• Screening for lung cancer

• Screening for colorectal cancer

• STD screening and counseling

• Blood Pressure screening

• Depression screening

• Autism screening

• Smoking cessation screening

SEE ALSO: High Blood Pressure & Health Insurance

Need help?

If you’ve got questions about individual health insurance NC, or need help buying health insurance NC, our local North Carolina health insurance agents can help. We’ll work out the correct type of coverage for your needs so you can find the best health insurance North Carolina. Compare plans online or get in touch with us today.