Obamacare: Pre-existing conditions

I have arthritis in my jaw, and had physical therapy for it a few months before I got a new job and a new health plan.  It is acting up again and I think I need more therapy.  How long do I need to wait to be treated so it will not be considered a pre-existing condition?

Aching and Waiting

Dear Aching and Waiting,

A pre-existing condition is any illness that you had treatment for in the 6 months before you joined the plan. So, while you definitely have a pre-existing condition, you do not necessarily have to wait to get care.

True, your plan can refuse to cover treatment for the illness for up to 12 months. But they have to subtract one month for every month that you had uninterrupted health insurance coverage. So, if you were on your previous plan for at least 12 months, the new plan covers everything – including your pre-existing condition. If you had a 63-day gap in your health insurance in the 12 months before you join a group health insurance plan, then the plan starts counting from the end of your gap to your enrollment date.

Under health reform (“Obamacare”), insurers have to cover pre-existing conditions and cannot refuse to sell you a plan based upon your having a pre-existing condition. This begins on January 1, 2014.  Until then, you might have some waiting to do!


Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.