Pre-Existing Condition

A pre-existing condition is a health problem you had before a new insurance policy started: diabetes, asthma, a prior cancer, a pregnancy. Before 2014, insurers in the individual market could refuse to cover you, charge you more, or exclude that condition from coverage for a year or longer. The Affordable Care Act ended those practices for ACA-compliant plans.

I sold policies in the years when the answer to a diabetic applicant was often simply "declined." Today, marketplace plans and employer plans must accept you and cover the condition from day one at the same price as anyone else your age in your area. The exception is worth knowing: short-term limited-duration plans and some association plans are not ACA-compliant and can still ask health questions, exclude conditions, and rescind coverage. Those plans look cheap on the quote page for exactly that reason. Medicare supplement policies can also apply pre-existing waiting periods outside of your initial enrollment window.

The takeaway: if a plan asks about your health history on the application, it is not an ACA plan, and it can decline to pay for the very condition you're most likely to need care for. Read the exclusions before the premium.