How Does a Pre-Existing Medical Condition Affect My Ability to Get Health Insurance?

Don’t we all have some pre-existing condition? To quote from an unknown author, “No one is prefect…that’s why pencils have erasers.”So what is a pre-existing condition?Imagine you contact a car insurance agent on a Monday morning to tell him you need car insurance to pay for repairs on your car that is currently in the shop being fixed because of an accident you had on Friday night. Your agent tells you that he would be happy to help you take out car insurance for future accidents–after the vehicle is fixed and drivable. Even car insurance companies look at pre-existing conditions as a huge concern. Why? Simply put–we all “follow the money.”Think about it, if insurance companies would cover all pre-existing conditions, then we would not purchase car insurance, homeowners insurance, life insurance, health insurance, or any other type of insurance until we “needed it.” By the time of our accident, it is too late to purchase insurance.A pre-existing condition then is exactly what it sounds like. In the case of health insurance, it is a health condition which the person already has when applying for health insurance. Whether it has been diagnosed by a doctor or known only by you, whether it is untreated, being treated or under control…. It is all the same.Here’s where we need to be reminded of what insurance actually is and does for us: (1) “A contract whereby an insurer promises to pay the insured a sum of money or some other benefit upon the happening of one or more uncertain events in exchange for the payment of a premium. There must be uncertainty as to whether the relevant event(s) may happen at all or, if they will occur (e.g., death) as to their timing.”(2) “A system to protect persons, groups, or businesses against the risks of financial loss by transferring the risks to a large group who agree to share the financial losses in exchange for premium payments.”So who is the authority on whether or not we have a pre-existing condition?Easy–medical doctors! Every time your medical doctor writes information on your medical chart, that becomes “gospel,” and only that doctor or another doctor can change it. So it is vital to get copies of all your medical information when you visit your doctor. You need to read over them and file them away for future needs. If you have taken prescriptions for medical reasons, than those medical issues can also be classified as pre-existing conditions.How can I keep pre-existing issues at a minimum when purchasing health insurance?(1) Buy group insurance through your employer, because most of the time pre-existing conditions are not an issue. But this will make your group insurance more expensive.(2) Purchase a strong “top of the line” individual insurance plan. Good insurance companies will have solid plans where you will not need to be changing every year or so for another plan. It is important to stick with one insurance plan for five to six years, and then research other options to see if you can find a better plan for a lower premium.(3) Purchase health insurance when you are young, before you get a debilitating pre-existing condition. If you are a parent reading this, please help your adult children (ones that are no longer under your health insurance) get affordable health insurance. Remember, the higher the deductible, the lower the premium.(4) Negotiate with the insurance company. They may reject you for health coverage, but then they may not. You may have to pay higher premiums, or you may have to “waive” away your right to be treated for the pre-ex, while still getting health coverage for everything else. Remember, some health insurance is better than no health insurance.As an insurance agent/broker, I hope that our government will eradicate pre-existing conditions on all individual and group health insurance plans. Yes, we realize the premiums will increase a bit because of that; but if we force everyone to have health insurance, than it can help keep health insurance premiums lower. The more people insured means the risk is shared across the board– which helps keep the premiums lower.So the good news is that we have choices to fit our individual needs. So to keep pre-existing insurance issues at bay, purchase a good solid insurance plan before medical problems happen to you.

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