Pre-Existing Condition List


Thanks to the Patient Protection and Affordable Care Act, pre-existing conditions are now accepted by all insurers in all states under federal law. Prior to this law, every state and insurance company had the liberty to restrict health plan availability to the young and healthy, otherwise increasing rates or issuing declines due to medical history or health problems. The following details common pre-existing conditions subject to rate-ups or declines before the laws changed.

Every state had its own definition of a pre-existing condition, though for the most part, many medical conditions were regarded as such no matter where you lived. Having had one of these conditions makes it more difficult to get insurance, especially with a large look-back window that many states implemented. Some of these conditions would be an obvious issue, especially because health insurers could deny coverage based on their estimation of how much the person would cost to cover. Other less severe conditions were a bit more surprising, yet would still determine health insurance premium costs and benefit limitations.

Below is a list of common illnesses and conditions, which typically defined a high-risk individual based on the underwriting criteria of several insurers and high risk pool eligibility in different states. Depending on how long ago you were diagnosed or when you received treatment, your eligibility for coverage was jeopardized — in which case you could have qualified for PCIP from mid-2011 until early 2013. Each state had its own laws and health insurers were usually free to use their own judgment when underwriting, which caused variance in what was considered high-risk from place to place. Based on where you lived and the insurance company you applied with, these conditions could result in a decline, increased premiums or limited coverage.

The good news? The expiration date on this sort of discrimination was December 2013. Keep in mind, however, the PPACA doesn’t require health plans to cover all types of medical care just because you can now get insured with an illness.