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  • Writer's pictureSara Yuen

What Is a Pre-Existing Medical Condition?

Updated: Jun 28, 2022

If you have shopped for health coverage, you have likely heard the term "pre-existing condition." While this is a commonly-used phrase in the health insurance industry, many individuals might have questions about what this term refers to –– and how having a pre-existing condition could impact their ability to qualify for health insurance coverage.

In this article, the team at Trusted Referral Network will answer some common questions about pre-existing conditions and explain how a pre-existing condition can impact eligibility in the eyes of health insurers.

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Pre-Existing Conditions Defined

According to, a pre-existing condition is a health problem an individual has been diagnosed with before starting their new coverage. These conditions include heart disease, diabetes, asthma, cancer, and others, and health insurance providers may no longer deny coverage to an individual on account of their pre-existing condition. Depression and anxiety also may be considered pre-existing health conditions by some insurers.

Pre-Existing Conditions and Eligibility

Prior to the passage of the Affordable Care Act (ACA) in 2010, health insurance companies could refuse coverage, limit benefits, or charge inflated rates due to their health status. However, with the passage of the Affordable Care Act, it became illegal for companies to deny individuals with pre-existing health conditions insurance based on their condition alone.

There are exceptions to this rule. Individuals previously enrolled in a health plan before 2010 may be part of a "grandfathered plan." These plans may not necessarily include some or several of the protections offered by the ACA, and health insurance plans with grandfathered status can raise premiums based on a pre-existing condition.

How Pre-Existing Conditions Impact Americans

According to the Centers for Medicare and Medicaid Services, a federal government website, roughly 82 million Americans relying on employer-based health coverage have a pre-existing condition. Individuals with these conditions could be denied coverage without the ACA's protections. In fact, before the ACA, a survey found that 36% of those who tried to purchase coverage directly from an insurance company in the individual insurance market were denied health insurance.

Many pre-existing health conditions are determined by the insurance companies themselves, making it difficult to determine exactly how many Americans have pre-existing health conditions. However, the CMS estimates that –– from the number of individuals who have gained protections from the Affordable Care Act –– "one in two Americans has a pre-existing condition." If this estimate is correct, that equates to hundreds of millions of Americans who would have been formerly ineligible for health benefits due to a pre-existing health condition.

Get the Coverage You Deserve with Trusted Referral Network

Despite the ACA's protections, pre-existing medical conditions can still change the way you shop for insurance –– and it is crucial to choose the right health care plan for your needs. Though it is illegal for a health insurance carrier to be denying coverage for pre-existing health conditions, finding the right plan can still be a challenge.

Trusted Referral Network can help pair you with the right coverage for your specific needs, ensuring that your health issues and chronic conditions are covered.

Find the Health Insurance Coverage You Need, at a Price You Can Afford.


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