Enrolling in insurance can be difficult if you have a pre-existing condition. cancer, diabetes, neurological issues, heart conditions, or even a history of hospitalization can prevent you from getting a health insurance policy at an affordable rate.
Traditionally, pre-existing conditions have prevented enrollment in health insurance. Individuals who have a history of these health conditions are considered at higher risk for filing a claim.
Since health insurance is all about risk, insurance companies do not want to take you on as an enrollee if you file a claim during the year.
Here is how pre-existing conditions affect your insurance premiums for health insurance, life insurance, and Medicare.
Health Insurance
When the Obamacare Act passed in 2011, it required health insurance companies to not hold pre-existing conditions against you when you enrolled in health insurance. This means that if you did have one of these pre-existing conditions, you could still get a health insurance policy at an affordable rate and qualify for any subsidy savings that are available through the state or federal Marketplace that you are enrolling in.
However, some states offer private plans that do not have this feature, and they require you to submit a health assessment based on your health history. This could disqualify you from any benefits because you would be considered at risk for filing a claim.
Additionally, policies that provide supplemental coverage in the case of an accident or illness through a cash benefit could deny you based on your health history (or even your family’s health history) because it could be expensive to pay out a claim if this medical occurrence was not recent, but a result of your pre-existing condition. (Examples would include a car accident because of a diabetic emergency or a relapse in cancer).
Unfortunately, if this is the case your options could only be limited to the marketplace, and if your income is too high to qualify for any premium assistance, you must pay the full price for a plan.
Life Insurance
When you enroll in life insurance, your pre-existing conditions are one of the main determinations of your premium. Unless you enroll in a life insurance policy with a small death benefit that has quick underwriting, you will likely be subject to a phone exam as well as a nurse coming to your home and taking blood work. You also would have to report any pre-existing conditions to the insurance company before you enroll.
Additionally, even if your pre-existing conditions are managed through medication, life insurance companies will look into this before they offer you your final rate.
Compared to those with no pre-existing conditions your rate will likely be higher because you would be at a higher risk of filing a death benefit due to needing extra care because of your pre-existing condition or dying unexpectedly due to complications.
Also, it is not guaranteed that all insurance companies will accept you if you have a pre-existing condition, so it is important to work with a broker, as they know which insurance companies will accept you based on your pre-existing conditions.
Medicare
When you enroll in Medicare when you turn 65, your pre-existing conditions are not taken into consideration. This can be helpful if you are enrolling in a Medicare Supplement Plan because these plans consider your health history when you enroll.
Similarly, if you are enrolling in a Medicare Advantage plan you do not have to submit any health questionnaires, regardless of when you enroll.
Deciding on which plan is best for you depends on your Healthcare use. If you qualify for a Medicare Advantage plan with extra assistance based on having a chronic illness such as a heart condition or diabetes, it could be very beneficial to have that $0 a month premium as well as discounts on specialist visits and prescriptions.
Similarly, if you take specialty drugs or have many specialists that you see monthly, enrolling in a Medicare Supplement Plan when you turn 65 can be a good option because you will have the most flexibility to see whichever doctors you want and you will be covered in full after you meet your yearly deductible.
Overall, Medicare is accommodating when it comes to pre-existing conditions because seniors may have more health concerns as they age.
It should be noted, that if you do decide to switch from a Medicare Advantage plan after you turn 65, you will have to fill out a health questionnaire. If in the last few years, you were diagnosed with health conditions, your monthly premiums for your Medicare supplement plan would be double or triple that of a beneficiary who is healthier.
In conclusion, if you have a pre-existing health condition, there are still options to get insurance. Working with a broker can be a good first step because you can be surprised at what options are available to you. Getting the care you need can be essential to managing these conditions, and you should not feel like you are unable to access healthcare at an affordable rate because you can’t get health insurance.