Pre-Existing Conditions
Most insurance companies use one of two definitions to identify such conditions. Under the "objective standard" definition, a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan. Under the broader, "prudent person" definition, a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment.

Sometimes regulated by state laws. Some states required insurance companies to use the objective standard, while others required the prudent person standard. 10 states did not specify either definition, 21 required the "prudent person" standard, and 18 required the "objective" standard.


Advocates against pre-existing condition rules argue that they cruelly deny needy people treatment.



Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

These rules went into effect for plan years beginning on or after January 1, 2014.

What This Means for You

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

One Exception: Grandfathered Plans

The pre-existing coverage rule does not apply to “grandfathered” individual health insurance policies. A grandfathered individual health insurance policy is a policy that you bought for yourself or your family on or before March 23, 2010 that has not been changed in certain specific ways that reduce benefits or increase costs to consumers.

Pre-Existing Condition Insurance Plan (PCIP) Coverage

The Pre-existing Condition Insurance Plan (PCIP) ended on April 30, 2014.  The PCIP program provided health coverage options to individuals who were uninsured for at least six months, had a pre-existing condition, and had been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. Now, thanks to the Affordable Care Act, health insurance plans can no longer deny anyone coverage for their pre-existing condition, and so PCIP enrollees can transition to a new plan outside of the PCIP program.  Learn more about your health insurance options at

What is your pre-existing condition?

Below fill out your pre-existing condition and what you'd like to say about the concerns of future health care.


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  • Robert Bostelmann (Monday, October 29 18 12:36 pm EDT)

    My son and I have hypocondrapla. Is that a pre- existing condition? Asking in the political campaigns in what it's being used. Thank you

  • President of LPOTW (Monday, October 30 17 01:19 pm EDT)

    I've had chronic back and leg problems since I was a young kid. Many people thought it was fake for the longest time like I was normal, in fact later they found out the hard way from the suffering and the pain I went through just how bad it was. I can tell you the having stenosis of the back and nerve pain that is constant from the back into your legs is no laughing matter. From a early age doctors are always concerned on many different levels from those who have dwarfism from birth ongoing. They measure mass brain amount vs. water of the brain, ear problems, ankle, legs, and so much more. With over 200 different types they still have yet to get everything down and are always working on it.

  • Michaela Stevens (Monday, October 30 17 12:13 pm EDT)

    I have chronic pain. If i cant get the physical therapy and meds that i need, that sucks. I have something new medical happen to me every couple months it seems, so if i cant get help, im screwed



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