Finding Individual Health Insurance with a Pre-Existing Condition

In the insurance world, a pre-existing condition is any medical condition you have had before you tried to get health insurance coverage. It could be an illness, an injury or any complication resulting from either. It could be something you saw a doctor about or received treatment, advice or consultation for within a specified period of time prior to seeking new coverage. Every insurance company will have its own definition of a pre-existing condition and its own “look-back” time period, which can be anywhere from six months to five years or more.

Contrary to popular opinions, having a pre-existing medical condition will not automatically exclude you from obtaining health insurance. Nor does it necessarily mean you can’t find affordable health insurance. It may, however, exclude you from receiving treatment for that specific condition under the terms of your particular policy for a specified period of time – generally nine to 12 months.  Here again, depending on your health insurance plan and your circumstances, the insurer may elect to waive the waiting period. This will typically happen if you’ve had health insurance coverage in place for at least 18 months with a gap in that coverage lasting no longer than 63 days—for instance, if you’ve changed jobs.

If you have or are eligible for medical insurance through your job, the rules the insurance company applies to pre-existing conditions will be different, and typically less strict, from those applied if you’re seeking an individual health insurance coverage. It may take more effort to locate a individual health plan, but it’s not impossible and using Internet sources makes it much easier than it used to be. If you’re having difficulty, some of the things you can do:

•    Form your own group. The rules will vary from state to state, so check with your state’s insurance commission, but many states allow individuals to form a group of one or two. Doing so may enable you to avoid denial of coverage or paying higher premiums for a pre-existing condition. It might also mean the exclusionary coverage period for your pre-existing condition is shorter.

•    See if your state has a high-risk pool you can join. Thirty states do, and they provide health insurance for people whose pre-existing conditions prevent them from otherwise finding affordable medical insurance.

•    Check with your professional organization, service clubs or other group you belong to. Many offer group policies to members.


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