Health Insurance 101: What Is a Pre-Existing Condition?

Pre-existing conditions are chronic health problems (like asthma, diabetes, or cancer) that you had before your healthcare coverage began. Historically, insurers were able to opt out of providing coverage for a member’s pre-existing condition after receiving a claim for its treatment. However, if you developed these illnesses after you signed up for insurance, they would be obligated to cover the required services.

By law (under the Affordable Care Act), insurers can no longer refuse to cover treatment or increase out-of-pocket costs for your pre-existing condition. This is also true for pregnancy: Insurers must cover the costs of childbirth and up to 60 days after. This remains effective even if the pregnancy started before enrolling in the insurance plan. Insurance companies consider maternity and newborn care to be “Essential Health Benefits.”

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Written by:

Hilary Weissman

Hilary Weissman has been a health writer for the past 6 years. She was a senior copywriter at WW (Weight Watchers) before joining GoodRx and was also a copy editor in S&P Global’s structured finance ratings group for 3 years prior.

Reviewed by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

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