If I have a pre-existing condition, how does HIPAA protect me?

Dr. Michael Roizen, MD
Internal Medicine

HIPAA (Health Insurance Portability and Accountability Act) protects you if you have a pre-existing condition in several ways. First, if you switch jobs or take a new job that offers a group health plan, you can’t be denied access to that healthcare plan just because you have a pre-existing condition. The new group plan can, however, exclude you from coverage for that particular pre-existing condition for up to 12 months. This is a compromise that HIPAA brought about. Before the law, the plan could just deny you coverage for that condition…forever! The law also lets you reduce (or completely get rid of) that 12-month exclusion period, if you had continuous health insurance coverage in the last year (meaning coverage that had breaks no longer than 63 days).

Happy? Then just wait a second. The insurance companies distrust each other and you. So, the story’s a little different for individual insurance. If you had group insurance and lost it, then HIPAA prevents the individual plans from denying you coverage as long as you had continuous coverage for 18 months. However, HIPAA can’t protect you if you only have an individual insurance plan, so an insurance company can still refuse to give you insurance based on a pre-existing condition…that is until 2014 at which point, the Affordable Care Act (aka ObamaCare) will go into full effect and health insurance companies will no longer be able to discriminate against people with pre-existing conditions. No matter what.  

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.