GEA - What Are Pre-Existing Conditions & Are They Covered By My Insurance Plan?
GEA - What Are Pre-Existing Conditions & Are They Covered By My Insurance Plan?
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GEA - What Are Pre-Existing Conditions & Are They Covered By My Insurance Plan?

February 9, 2024

Health conditions are a natural part of life, and as responsible individuals, we seek to protect ourselves and our loved ones by investing in comprehensive insurance plans. However, when it comes to pre-existing conditions, navigating insurance coverage can become a complex maze. In this blog, we will shed light on what pre-existing conditions are and explore whether insurance plans typically cover them. Understanding these critical aspects enables you to make informed decisions about your health and financial well-being.

What Is a Pre-Existing Condition?

Pre-existing conditions are any medical or health conditions that an individual is diagnosed with before a new health insurance plan begins. Chronic illnesses such as cancer, diabetes, depression, and epilepsy may be considered pre-existing conditions. Even pregnancy before enrollment could be considered. Other conditions such as depression, asthma, and acne may qualify as well. 

Can I Be Denied Health Insurance with a Pre-Existing Condition?

If you have a pre-existing condition, you may be wondering if you could potentially be denied health insurance. The answer is no, you cannot be denied health insurance due to a pre-existing condition. Thanks to the Affordable Care Act passed in 2010, it’s illegal for insurers to deny coverage, limit your coverage, or charge you higher rates.

However, there are exceptions. Individual plans purchased on or before March 23, 2010, are considered “grandfathered” and may not include some rights and protections provided under the Affordable Care Act. Some non-traditional plans may not be subject to ACA regulations resulting in not covering pre-existing conditions. These plans include short-term health insurance plans with a term of less than a year and travel insurance with international medical coverage.

Are There Specific Plans for Individuals with Pre-Existing Conditions?

While there aren’t specific health insurance plans for people with pre-existing conditions, there are plans that may benefit you more. For example, if your pre-existing condition requires regular care, surgeries, or treatments, then selecting a plan with a higher monthly premium and lower deductible might be the best option. You would receive the coverage needed and have more manageable, predictable costs. Doing your research on the different plan types and costs is the best option if you have a pre-existing condition. 

What Can Affect My Costs?

Providers cannot charge you more due to pre-existing conditions, but other factors could increase your costs. 

  • Age: costs can be up to 3 times higher for older individuals than younger ones.
  • Location: state and local rules, cost of living, and competition are taken into consideration.
  • Tobacco Use: you could be charged up to 50% more for using tobacco products.
  • Dependents: plans that cover spouses/dependents can cost more than an individual policy.

What Options Do I Have?

Having a pre-existing condition shouldn't deter you from obtaining the insurance coverage you need. By understanding how insurance plans handle pre-existing conditions and carefully choosing the right policy, you can safeguard your health and financial well-being. Remember to research, ask questions, and be transparent about your medical history when applying for insurance. Stay informed, stay protected, and make the best decisions for your health and peace of mind.

A great, cost-effective option is to add a supplemental insurance plan. A supplemental plan is an addition to your primary health plan and helps cover out-of-pocket expenses. These costs could include co-pays, cost shares, ER visits, and more! 

At GEA, we offer a supplement insurance plan for TRICARE members because we want to help ease the burden on your wallet. A TRICARE Supplement Insurance Plan can help cover co-pays, ER visits, and more. Are you interested in learning more about our supplement plan? Speak to one of our specialists today!Speak with a Product Specialist  888-214-0794


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