Wednesday, April 17, 2024

Pre-Existing Conditions 101.

June 19, 2017 by  
Filed under Health, Money/Business, Politics, Weekly Columns

(Akiit.comAs Trumpcare continues its way through the legislative process, there’s a lot of worry and concern about what is going to constitute a “pre-existing condition”. Given the fact very little is known about the AHCA, it’s difficult to be sure just how justified this concern is. There is a general consensus, however, that people with pre-existing conditions will see an impact on the cost of their healthcare coverage as a result of the AHCA.

Why Should I Worry About Pre-Existing Conditions?

In essence, a pre-existing condition is an illness or health concern that means insurers could do one of the following:

  • Refuse to offer coverage outright. With Trumpcare, it’s suspected that more insurers will be able to refuse coverage to those with expensive healthcare concerns. This could leave people with long-term illnesses unable to obtain cover even for illnesses unrelated to their pre-existing condition.
  • If they do offer coverage, insurers are liable to charge far higher premiums for even basic care. Studies have shown that sufferers of depression could see a 50% premium increase compared to a non-depressive, while those with metastatic cancer could see a 3,500% increase. Those figures are so huge they almost seem ridiculous, but they’re very real.

So What Is A Pre-Existing Condition?

In short… no one knows. The definition has yet to be fleshed out in terms of what it means in a legislative sense.

What we do know is a brief overview of what is currently considered to be a pre-existing condition. The list is long and – for most adults – they will likely find that they have at least one of the conditions.

Why Are Pre-Existing Conditions Making Insurance More Expensive?

Insurance is a numbers game. If someone has a condition when they take out their policy, compared to someone who doesn’t have that condition, they are more likely to need their insurer to pay for treatment. To cover this extra cost to the insurer, they raise the premiums for those with existing illnesses.

It is also done as a kind of provision against the future. For example, people with Celiac Disease will find an increase in their premiums. Celiac, after health is stabilized, is a relatively cheap condition to treat – the main “medication” is a gluten-free diet. So you’d think it wouldn’t impact insurance premiums much, given the management of the financial side of this diet would be undertaken by the sufferer rather than their insurer. However, people with Celiac have a much higher risk of suffering from gastrointestinal cancers such as bowel and stomach cancer in the future, so their premiums are raised in case this happens. This makes sense on one level, but given these cancers overwhelmingly impact the over-50s, it’s harsh that a 21-year-old Celiac would find their premium raised on a “just in case” that might not cash in for 30 years.

How Can I Stop This Impacting Me?

To an extent, you can’t. If you’ve been diagnosed with a condition and it is on your health records, you have to tell your insurer. It’s fraud if you don’t and you won’t be covered.

The problem comes when you don’t think you have a pre-existing condition and you obtain coverage on that basis. Ignorance is not an excuse, or so the insurance industry has enshrined in their policies. If they suspect that a condition you have later on is caused by a pre-existing condition, then they will refuse coverage – even if you had no idea you had the pre-existing condition in the first place.

It therefore makes sense to ensure you know all you can about your health before obtaining a new policy. Be thorough, too. A full medical is a good place to begin as is a round of blood tests. Cover all the bases, from checking for Celiac and other autoimmune conditions to consulting with regarding sexual health concerns. Get a copy of all of these results, scan them, and keep the originals too – you don’t want to lose the proof you were healthy when you took the policy out. This will go some way to protecting you if your insurer ever tries to claim you concealed (either knowingly or through ignorance) a pre-existing condition.

What Sort Of Conditions Do Insurers Call “Pre-Existing”?

All we have at the moment is the knowledge of what insurers currently call pre-existing conditions. So, if you suffer from any of the following, Trumpcare could post a big concern for you.

  • Lupus – an autoimmune condition that causes the immune system to attack itself.
  • Epilepsy – a neural disorder that causes fits and seizures.
  • Hepatitis – an inflammatory condition that affects the liver, sometimes caused by excessive alcohol consumption.
  • Obesity – having a body weight above the recommended level.
  • Pregnancy – having been pregnant before, or being pregnant at the time of taking out the policy; both are considered to be “pre-existing conditions”.
  • Alzheimer’s Disease – a degenerative condition that attacks the brain and cognitive function.
  • Diabetes – a dysfunction of the ability to regulate blood sugar and insulin.
  • Sleep apnea – a sleep condition where the sufferer temporarily stops breathing during sleep. Millions of people have this condition without having any idea of it; only a sleep study can diagnose it. If you snore, this might be a concern for you as explains.
  • Anorexia – a mental illness that causes the sufferer to starve themselves of calories.

Then there are conditions that experts believe could fall into the pre-existing bracket under Trumpcare:

  • Acne – zits, spots, whatever you want to call them.
  • Migraine – a cerebrovascular condition that causes severe headaches and nausea.
  • Asthma – a lung condition that causes shortness of breath and wheezing.
  • Ulcers – anywhere on the body, including the stomach lining.
  • Narcolepsy – a condition where the sufferer is prone to falling asleep without warning as explained at
  • Acid reflux – a common condition which causes heartburn and stomach discomfort.
  • Seasonal Affective Disorder – a mood disorder better known as SAD, sufferers of which experience extremes of low mood during the winter months.

Until this bill becomes law, it’s impossible to know just how concerned you should be. However, by obtaining all your medical evidence of your state of health at this time, you have some protection against the future. The rest, sadly, will just have to reveal itself in good time.

Staff Writer; Matt Parker

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