More than 130 million Americans have some type of pre-existing condition. That is nearly 1 in 4 Americans. This can be anything from asthma to high blood pressure, diabetes, epilepsy, heart disease, or even pregnancy. Chances are, someone you know has a medical condition that requires some type of ongoing treatment, prescriptions, or frequent doctor visits.

If you or someone you love is living with a pre-existing medical condition, the insurance world hasn’t always been a friendly place. For many, the cost of insurance combined with the cost of care has forced them into bankruptcy.

The Affordable Care Act

Prior to the passage of the Affordable Care Act (ACA), insurance companies had the right to charge people whatever they wanted or deny coverage completely. Anyone with pre-existing conditions couldn’t find good coverage at an affordable price for their medical needs. They were either denied coverage completely, or their premiums were so high, they couldn’t afford the options available to them.

It’s important to keep in mind this did does not apply to group coverage provided by an employer. For those on a group plan, many pre-existing conditions were covered without any problems or price increases.

But for Americans who were self-employed, had a job with a company who doesn’t offer benefits, or experienced a change in life circumstances that leaves them without insurance, they had little to no options. As a result, many were drowning in healthcare costs while their conditions worsened over time due to inadequate treatment.

In 2014, the ACA put a ban on pre-existing condition exclusions. This means that in the world of insurance, all policyholders are created equal regardless of your medical history. Today, all insurance plans must cover treatment for existing medical conditions without charging the policyholder more in their premiums. They also cannot raise your rates based only on your health. This is great news for millions of Americans who suffer from any type of health condition.

The Exception

There is one exception to the ACA rule. Grandfathered plans are policies purchased on or before March 23, 2010 that have not been changed since. These plans do not have to over pre-existing conditions or preventative care. If you want more coverage than you have under your grandfathered plan, you can switch to a marketplace plan during open enrollment.

The solution for dealing with pre-existing conditions is a hot topic on Capitol Hill. It will continue to be debated over and over. Some legislatures still believe the open market is the best way to provide leading medical coverage. Others believe that the government has a responsibility to provide for its citizens, helping those who can’t help themselves. Some have even suggested to provide two separate markets, one for healthy Americans and a separate insurance system for those with pre-existing conditions.

Congress may continue to spend several future decades debating the effectiveness and efficiency of the American health care system. However, providing Americans with proper healthcare coverage and access to both preventative care and life-saving treatments without restrictions is a step in the right direction.


If you have a pre-existing condition, then you know how difficult it was to get health insurance back in the day. Learn how the Affordable Care Act changed that and what it means for you.