Understanding Pre-Existing Conditions & Affordable Care Act (ACA)

Insurance companies define a pre-existing condition as a medical condition that was diagnosed before a person had health coverage. The Patient Protection and Affordable Care Act of 2010 directly affects how insurers use pre-existing conditions.

Children

• The law prohibits health insurance companies from denying coverage for pre-existing medical conditions for children less than 19 years of age. This provision will be effective as of Sept. 23, 2010.

Federal Subsidies

• The act will prohibit the exclusion of pre-existing conditions for adults beginning Jan. 1, 2014. In the interim, eligible individuals with pre-existing conditions can apply for federally subsidized health insurance through HealthCare.gov or a local insurance company. The federal government has set aside $5 billion for this program, which will be available until the funds are exhausted or the reform rules regarding pre-existing conditions are fully effective.

Considerations

• Health insurance companies will be strictly regulated on how they can charge for insurance. They will not be able to charge higher rates based on health status, pre-existing conditions or gender. Premiums for plan years beginning in 2014 or later can vary based only on limited factors, including tobacco use, family size and geography.