Medical insurance won't cover you if you are sick?

Question

Is it true that medical insurance companies in US won't admit you to their plan if you have pre-existing medical condition?

Answer 1

Let's eliminate insurance companies.

Answer 2

In general, yes, it's potentially true for individual health plans. (It does depend on the pre-existing conditions. Some they rate up for, some they decline outright.)

Group plans work differently. Groups are not allowed to decline coverage, although they may impose waiting periods (depending on the plan options chosen by the employer.)

Most states do offer some kind of coverage (either through a state-sponsored plan, or by mandating that at least one insurer doing business in the state) through what's called "open enrollment" plans. These plans can't decline anyone for almost any reason. (There are a few exceptions.) However, the rates for these plans is usually outrageous AND they still generally won't cover for pre-existing conditions for the first 6-12 months.

While they can decline individual applicants, this does NOT mean that they can decline to pay the claims, or refuse to renew your insurance if you had an active policy (unless there was fraud committed at the time of application -- meaning that you knew of the pre-existing condition and didn't list it.) Which is why it's a smart move to get insurance, even if you think you're perfectly healthy and think you're too young to have any serious health issues. (I was only 28 when I was diagnosed with some health issues that would block me from getting health insurance. There's no real way to predict when this kind of thing might happen.)

Answer 3

If you have a pre-existing condition and have been covered by another plan for the past year, many insurance companies will still cover you. Your premiums may be much higher than average, but you can get some form of coverage. Some companies may also deny coverage for that particular condition for a certain number of months, even if they will cover you for other events. Call around and ask different companies what their policy is, or investigate online.

Answer 4

If you currently have coverage and are changing insurance because of a job change, you most likely will still have coverage but check with the HR department to make sure they don't have a pre-existing condition clause on their health insurance.

Some companies have a pre-existing clause but if you go for some period of time without treatment, they will start covering you. That doesn't help if you have a chronic condition like diabetes where you can't go a year without treatment.

You are going to have to check the exclusions on any policy and see if they cover your pre-existing condition. It will depend on the policy.

Answer 5

It depends. If you had insurance previously, and are only switching from one plan to another (say Aetna to Blue Cross Blue Shield) they have no choice - all pre-existing clauses are waived.

That said, some plans have what they call a "pre-existing clause" - meaning, if you have a chronic condition such as asthma or diabetes, they reserve the right to not pay for treatment of these conditions for a pre-determined amount of time. (Anywhere from 30 days to a year.) WHICH, if you have these conditions and maintain them properly, you shouldn't need treatment, aside from the occasional mishap or maintenence.

Answer 6

It depends on the company and your "condition". No company is FORCED to cover anyone. They can decline you based on their rules (underwiting).

Answer 7

Sometimes! Sometimes it's not true - like if you've had continuous coverage.

Answer 8

Anthem will, I am pretty sure that no others will...and Anthem won't either if it was a workmans comp. situation...

Answer 9

it`s true for some but not all