If I buy a new health insurance policy today, will all my pre-existing conditions be covered?

January 24, 2013

"If I buy insurance today, I was told that insurance companies must cover all my pre-existing conditions immediately. Is this true?"

Well, not exactly. The truth is that even though the healthcare law passed on March 23, 2010, not all parts of the law are in place right now. The part that requires people to buy insurance, and therefore requires insurance companies to take everyone without any pre-existing waiting periods begins on Jan. 1st, 2014. If you buy health insurance today (prior to 1/1/14), insurance companies are allowed to put a pre-existing waiting period on both an individual AND a group health insurance policy.

HIPAA (the health insurance portability act) passed in 1996 did set some guidelines for group plans. If you move from an individual health insurance policy or a group health insurance policy TO A GROUP POLICY, there is no pre-existing waiting period as long as there has been no lapse of coverage of more than 63 days. The one exception is for maternity coverage – the federal law requires health insurance companies to cover this from day one on a group health plan regardless of prior coverage.

So what does this mean for you?

Let's say you take high blood pressure medication. This is considered a pre-existing condition because it is something you have been treated for, seen a doctor for, or shown symptoms of in the past 12 months. Let's also say that you were downsized from your job and chose not to take COBRA due to the cost. Three months later you are offered a job with benefits. You can get onto the group health plan, but because you had a lapse of coverage of more than 63 days, you will not have coverage for the HBP for a period of time – usually 6 mos or 12 mos, whatever the pre-existing waiting period is for the group health insurance policy. If the new job does not offer health insurance coverage and you decided to buy an individual health policy on your own, a pre-existing waiting period COULD apply.

Honestly, many companies are actually waiving the pre-ex waiting period if you have 1) had continuous coverage, and 2) they don't put a waiver on the condition (which they are still allowed to do). As we get closer to 1/1/14, my guess is that we won't see any pre-existing waiting periods... unless of course, Congress changes or modifies the law. There are some bills circulating now that would change the rules on pre-existing conditions... more to come later.

One last item: Regarding CHILDREN UNDER THE AGE OF 19: Under the new healthcare law, it is a requirement currently that there is NO PRE-EXISTING waiting periods for children. The "no pre-ex wait for kids" was also defined by HHS to mean "guaranteed issued". This simply means that children CANNOT BE DECLINED/DENIED for any reason! However, the insurance companies do have the right to charge extra premiums for 'higher risks' with children. Unfortunately, our office has seen rates as high as a 500% extra charge for children. If this happens to you, call our office immediately! We can help! We have suggestions to save you money.

And as always, call us with any of your health insurance questions: 630-279-1739