How Pre-Existing Conditions Affect Health Insurance?

How Pre-Existing Conditions Affect Health Insurance

Health Insurance is one of the leading financial planning aspects that we all think about in our lives. Health Insurances play an essential role in securing our futures; thus, the decisions related to the same have to be made with due diligence. It is not possible that everybody is on their best terms and is not ill. People who suffer from illness are in more need of insurance. People with pre-existing conditions are not likely to get insurance or face many more complications while applying for the claims. So, here we are with an article about how pre-existing conditions affect health insurance.


What is a pre-existing condition?

First, let’s understand what a pre-existing health condition is? A Pre-existing health condition is a situation or an illness that the insurer already suffers when starting with a new health insurance plan with an insurance company.

These conditions are generally chronic and long-term, affecting health insurance plans and policies to a great extent. Diseases like Cancer, Diabetes, heart disease, etc. are the kind of pre-existing conditions that the insurer has to reveal to the health insurance provider before finalizing the plan.


How Pre-Existing Conditions Affect Health Insurance

So, here are 6 points on how pre-existing conditions affect health insurance.


#1: Higher Premiums

If a person has a pre-existing condition, it has a significant effect on the premium amount. The patient is more prone to the disease turning into an emergency, and in such cases, the insurance company will have to provide the coverage. Thus, this probability makes the amount of the premiums much higher. The company analyses the risks of providing insurance to a person who already suffers from a medical condition. This leads to premium loading.

The best part is that even after the pre-existing medical conditions, the insurance companies cannot deny providing the people with medical insurance policies.


#2: Waiting Period

Waiting Period is one of the factors how pre-existing conditions affect health insurance. Many insurance companies agree to provide health insurance to people with pre-existing conditions. But there are some terms and conditions related to the same. One of the main clauses in such cases is the waiting period. The waiting period differs from the company to the company and also from plan to plan. The companies may agree to provide the courage after 3-4 years of starting the company’s health insurance plan.

Any illness and an accident met in between that waiting period is not a part of the insurance coverage claim. Thus, this is how pre-existing conditions affect health insurance.


#3: Premium Loading and Waiting Period

In some special cases, the insurance companies may elevate the premiums along with applying the waiting period. These are some special cases where the insurer is at a very high risk of getting ill but is looking at the health insurance policy. But some life-threatening diseases like HIV, Cancer, etc. are permanently excluded from the policies.

Thus before finalizing the policy, one has to understand the increased premium and the waiting period.


#4: Pregnancies

Pregnancies are not a part of the pre-existing medical conditions. Insurance companies cannot deny or elevate the premiums if a woman is pregnant. The companies do not see pregnancy as an illness, and they cannot work out the incentives accordingly.

Read Also: Difference Between Critical Illness Insurance and Health Insurance

The insurance companies cannot deny you the coverage or charge more. Coverage for pregnancy begins from the day you enroll in the health insurance plan.


#5: Experimental Procedures

This is another factor in how pre-existing conditions affect health insurance. But when one suffers from a pre-existing health condition, it becomes almost impossible for the insurer to get the companies to pay for the experimental procedures. With so many human trials going on with new diseases rising each and every day, it is next to impossible to claim the amount in such circumstances.

Every company has its definition of experimental procedures. People should read the policies and terms and conditions properly before entitling and agreeing to pay for a particular policy. Also, these procedures are quite expensive, and even if the companies provide you with the coverage for these experimental procedures, then the premiums will be very high.

If you undergo these experimental procedures and your claim faces rejection, you can appeal the decision. Generally, the result is in favor of the person who is claiming the amount, but if not, then one can proceed to the court.


#6: Switching Insurance Providers

There is a time in life when we are not proud of the amount of the premiums which we are paying and the result that is coming out. People often think of switching the insurance providers once in a while. But when you are suffering from a medical condition, it becomes difficult to change the companies. Every company does not provide coverage to people who have pre-existing medical conditions. In such cases, it won’t be possible to switch.

Also read: 6 Mistakes People Make When Shopping for Health Insurance

Other than that, every company has its policy related to providing coverage to people with medical conditions. One has to make sure; when switching, people carefully read the terms and conditions of the new insurance provider. The smart option is to look for a plan that provides better benefits compared to the one from which you are switching. Otherwise, there is no point in changing.

Keep in mind that the insurance companies make a profit if the customers do not get sick. Thus, taking onboard medically ill patients is not in their best interests. Therefore, make sure whatever benefits you are reaping, they are the best you can get from any insurance provider.


Myths Around How Pre-Existing Conditions Affect Health Insurance

There are myths around how the pre-existing conditions affect health insurance policies that the companies deny providing health insurance to people who have some pre-existing health problems. This is a big myth, as insurance companies cannot deny coverage. They have to provide coverage to every person. But the premium and the terms and the conditions can vary according to every person.



Pre-existing conditions affect health insurance policies to a greater extent. The amount of the premium profoundly differs according to the type of medical condition one suffers from. The more intensity of the illness, the higher the premium would be. Other than the premiums, the waiting period also plays a significant role. Almost every insurance company keeps a waiting period in pre-existing health condition policies. Thus, before finalizing the type of plan which you would choose for yourself and your loved ones.

Also read: 9 Ways to save money on Health Insurance

So, this was all, hope the article was informative. And if any questions are still buzzing and bugging you then reach us through the comments section.