Buying Insurance & Pre-Existing Conditions: FAQ

Medically Reviewed by Sarah Goodell on November 30, 2022

• How do I know if I have a pre-existing condition?
• Will health care reform laws make it easier to include a child with an ongoing health problem on my insurance plan?
• Will needing insurance coverage for a pre-existing condition make me have to pay higher premiums?
• What should I consider when shopping for a plan if I have a chronic condition?

Having a health condition such as diabetes, high blood pressure, cancer, or depression used to be a problem if you were shopping for health insurance.

That's all changed with health care reform.

Health insurance companies now can't turn you down or charge you more for health insurance just because you have a medical condition. They also can’t make you wait before getting or continuing treatment, and they can't drop your coverage.*

These protections all come from the Affordable Care Act.

*Short-term health plans do not have to cover pre-existing conditions. Short-term health plans include plans that provide coverage for less than 12 months (even those that provide coverage for 364 days). Because these plans do not have to comply with many of the requirements of the Affordable Care Act, make sure you know if your insurance is a short-term health plan.

How do I know if I have a pre-existing condition?

Pre-existing conditions are health problems you already have at the time you apply for health insurance. They can include:

• Life-threatening illnesses such as cancer
• Chronic conditions such as asthma, depression, diabetes, and heart disease
• Short-term things, like back injuries or pregnancy

Will health care reform laws make it easier to include a child with an ongoing health problem on my insurance plan?

Yes. As part of the Affordable Care Act, insurers are no longer allowed to deny health coverage to children because of a pre-existing condition.

Will needing insurance coverage for a pre-existing condition make me have to pay higher premiums?

Health plans can no longer use pre-existing conditions as a reason to charge you more each month for your premium.

Health plans will be allowed to adjust premiums based only on:

• Whether you have an individual or family plan
• Where you live, since medical costs are higher in some areas than others
• Your age
• Your current and past use of cigarettes or any other tobacco product

What should I consider when shopping for a plan if I have a chronic condition?

• Drugs: Check your plan’s drug formulary, a list of prescription medicines a health plan covers, to anticipate your drug costs .
• Self or care management: These programs are covered under plans bought through the Affordable Care Act Marketplaces .
• Doctor visits: Consider how often you’ll need to visit the doctor, including any specialists, for your condition. Make sure they are in your network to avoid higher out-of-pocket costs.