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What Are the Pre-Existing Conditions Covered by the ACA?

December 1, 2023

What Are the Pre-Existing Conditions Covered by the ACA?

If you have a pre-existing health condition, then you may be worried about whether your health problems might affect your ability to obtain insurance coverage through the Affordable Care Act (ACA). Every so often, there are changes in healthcare policy, and navigating the insurance landscape can be daunting. But not to worry, we have your back! Below, you'll learn all about the pre-existing conditions covered by the ACA. Find out more about getting health coverage when you have chronic conditions in the following sections.


What is the ACA and does it allow pre-existing conditions?

The Affordable Care Act is a law that aims to provide access to affordable health care to residents of the United States. One of the biggest changes the ACA made was requiring health insurance providers to cover a list of essential health benefits. Another one of the major changes it mandated was requiring insurers to cover Americans with pre-existing chronic health conditions.


Before this law was passed, health insurance companies were allowed to deny coverage or charge more for those with pre-existing health conditions. But thanks to the ACA, this is no longer the case! Insurers absolutely cannot deny coverage due to your health status. They also can't impose any lifetime limits on your healthcare coverage.


All health plans have to provide a set of specific health benefits, and neither gender nor health condition can affect accessibility or cost. So, if you have a pre-existing condition, you can rest assured knowing you can get affordable health insurance coverage. More importantly, you have the ability to choose from different plans to find the one that works best for you.


What qualifies as a pre-existing condition?

You'll find that there are several types of pre-existing conditions covered by the ACA. Check out some of the following conditions below:

  • Acne
  • Anxiety
  • Arteriosclerosis
  • Arthritis
  • Asthma
  • Cerebral Palsy
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congestive Heart Failure
  • Cancer
  • Depression
  • Diabetes
  • Dystrophy
  • Emphysema
  • Epilepsy
  • Hypertension
  • Kidney Disease
  • Muscular Dystrophy
  • Pregnancy
  • Severe Mental Health Disorders
  • Severe Obesity
  • Sleep Apnea
  • And many more

Before the ACA, any existing health conditions or issues that you had prior to enrolling in an insurance policy would allow the insurer to either deny you coverage or upcharge for higher medical care costs. But you'll be glad to find that health status is no longer a factor! You can access health services without having to worry about whether such conditions will affect the overall cost of medical care for you and your family.


What is the exclusion period for pre-existing conditions?



The exclusion period refers to the period in which insurance providers would refuse to cover any services related to your pre-existing condition for a set amount of time. Thankfully, with the ACA, this practice has now been eliminated. You can now get coverage for your condition from the start of your coverage date with no lifetime limits!


How do insurance companies determine pre-existing conditions?

To determine pre-existing conditions, insurance companies would use your health status and your medical history to decide how much they would charge. Your age, any existing conditions, family history, and lifestyle habits were all considered to determine your health risk. Insurance companies used this information to decide if they were willing to provide you coverage and what the cost of your health insurance coverage would be.


The ACA health reform now provides protection for anyone with chronic health conditions. So, companies can no longer impose any limits on your coverage, and people of any health status can get health benefits because of all the pre-existing conditions covered by the ACA.


What are some factors that affect health insurance costs?



Now that you're aware that pre-existing condition protections are in place under the ACA, you may be wondering what factors still affect the cost of obtaining new health coverage. We took the liberty of listing some of the factors that influence your health insurance premiums in the following sections.



Age affects the cost of premiums because the amount of health care you need typically correlates to your age. On average, older adults and seniors need more medical care and have a higher number of health visits compared to younger populations. This costs the insurer more money, so older adults and seniors usually have to pay more for their health insurance policies.



Some areas have higher medical costs because of differences in competition or state and local laws. The cost of living in the area also affects the overall cost of medical care.


Tobacco Use

Even though all pre-existing conditions are covered by the ACA, tobacco use still affects insurance costs. Tobacco users are actually more likely to develop conditions like cancer, heart disease, stroke, lung disease, diabetes, and chronic obstructive pulmonary disease (COPD). These conditions result in the need for more medical care every year, and insurers charge up to 50% more to tobacco users than to those who don't.


Level of Coverage

The plan category and the level of coverage you choose will also influence your monthly premiums. Some plans have lower monthly premiums and higher out-of-pocket costs or vice versa. The plan you choose ultimately depends on how much health coverage you need and how often you see a doctor or need prescription medications. Healthy adults who don't need much besides routine care and coverage for emergency visits can typically get away with choosing lower monthly premiums.


Number of Dependents

Insurers will charge more for an insurance plan that covers more than one person. If you're only paying for yourself, then you'll likely have more flexibility with finding a new health insurance policy. But if you also need coverage for your spouse and other dependents, then you'll want to look for providers with competitive pricing for each dependent.


Where do you get insurance that covers pre-existing conditions?

With the ACA upheld, you can rest easy knowing that you have your pre-existing conditions covered by the ACA. If you're looking for health insurance plans, you can check out our website to view options for Medicare insurance, ACA insurance, and even short-term medical insurance. Our comparison tool makes it a lot easier for you to review a variety of plans along with their health benefits. All you have to do is choose the insurance type and enter your ZIP code.


Our platform will show you a list of some of the best health plans that are available in your local area. You'll be able to find affordable coverage from reputable insurance providers. Remember to read the fine print and compare different benefits before signing on the dotted line!


If the process seems daunting, we totally understand. You can reach out to any of our licensed insurance agents to learn more about health insurance options for you. Just call 1-800-314-5594 on weekdays from 8 a.m. to 8 p.m. ET. They'll help you compare health plans online and find one that suits your health goals and also fits your budget.


Altogether, it's clear that the pre-existing conditions covered by the ACA are paramount for millions of Americans. The Affordable Care Act provides patient protection for people who were previously denied coverage because of their medical history. This provision helps ensure people with pre-existing conditions have access to necessary medical treatment without having to pay high medical expenses. So, if you or someone you know has a pre-existing condition, you need to understand the ACA's protections and take advantage of them.


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