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What Are Pre-Existing Conditions?

A pre-existing condition is a health or medical condition that existed before enrollment into a health insurance plan. Diabetes, cancer, asthma, back pain, heart disease and pregnancy are just some examples of pre-existing conditions.

Before the passage of the Affordable Care Act, also known as Obamacare, people with pre-existing health conditions were either denied health insurance coverage or were charged very high and sometimes unaffordable premiums.  Since the Affordable Care Act became a law, however, there is no reason for you to worry about being denied health insurance coverage or being charged high premiums because of pre-existing health reasons. The Affordable Care Act makes it illegal for health insurance companies to discriminate against medical conditions.  There is, however, one exception: grandfathered plans.

Exception: Grandfathered Plans

You should be aware of the only instance a health insurance company does not have to cover pre-existing conditions. If you obtained a health insurance plan before March 23, 2010 either through your job or on your own there is a chance your current health plan can have a pre-existing condition exception.  To understand if this exception may apply to you, you can either read through your health insurance plan benefits description or speak to your employer’s health care plan administrator.

It’s also important for you to understand that non-discrimination for pre-existing conditions under the Affordable Care Act applies only to health care and health care insurance companies. If you are looking for life insurance, or other types of insurance, please consult with a licensed  insurance agent or do some research to get current information.

Illness in America

Many Americans face the reality of illnesses. And for many people,  illnesses made it a burden to obtain affordable health care prior to the passage of the Affordable Care Act.

Here are some illness statistics from the Centers for Disease Control and Prevention:

  • Asthma
    • 1 million (9.5%)children in the U.S. have asthma
    • 9 million (8.2%) adults I the U.S. adults have asthma
  • Alzheimer’s Disease
    • 7,900 (7.5%) hospice patients have Alzheimer’s as a primary diagnosis
    • 231,900 (15.5%) nursing home residents have Alzheimer’s Disease
    • 83,494 people per year die because of Alzheimer’s Disease
    • Approximately 5.1 million in the U.S. may have Alzheimer’s disease
  • Breast Cancer
    • 211,731 women were diagnosed with breast cancer in the U.S. in 2009
    • 40,676 cancer deaths occurred in the U.S. in 2009
    • Breast cancer in the United States is the most common cancer in women, no matter your race or ethnicity


  • Diabetes
    • 9% of adults 20+ years have diabetes (diagnosed or undiagnosed)
    • 5% of adults 20+ years have diagnosed diabetes
    • 3 million medical visits have diabetes as a primary diagnosis
    • 69,071 annual deaths are due to diabetes in the U.S.
    • 9 million new number of cases of diabetes diagnosed in people aged 20+ years in 2010
    • 1 in 3 Americans will develop diabetes by 2050


  • Overweight, Obesity and Fitness
    • 2% of adults age 20+ years are overweight or obese
    • 9% of adults age 20+ years are obese
    • 4% of adolescents age 12-19 years are overweight
    • 18% of children age 6-11 years are overweight
    • 1% of children age 2-5 years are overweight
    • 48% of adults met neither the aerobic nor muscle-strengthening guidelines for physical activity in the U.S. in 2011


  • Heart Disease
    • 5 million (11.5%) adults have heart disease in the U.S.
    • 4 million annual medical visits and 2 million annual hospital outpatient department visits have heart disease as primary diagnosis in the U.S.
    • 597,689 annual deaths are due to heart disease in the U.S.
    • Cause of death rank in the U.S: 1



U.S. Department of Health & Human Services

Centers for Disease Control and Prevention


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