Pre-Existing Conditions

If you can't get insurance because of a pre-existing condition you should probably shop around. There are many plans that will not apply a pre-existing condition clause, and for those that do, most will waive that if you had insurance before your current effective date.

The real purpose of a pre-existing condition clause is to prevent people from only spending the money on insurance after they know they need it. Insurance is supposed to be a "just in case" situation and the premiums are based on the risk of the health care costs you will accrue. The idea is that you'll pay while using it little and that money will be there if you need to use it a lot.

Is it fair to the company which will cover you to go without insurance until you know you need it, and then expect them to pay for everything you've let go for years? I can already hear many people saying, yes it is, those evil insurance company bastards just want to steal my money and not cover me. This might be a slight exaggeration.

The healthy people paying their insurance premiums are paying for the sick people paying their premiums. It all goes into one big pool and the insurance company prays that they don't have to pay out more than they take in. The pre-existing clause is designed to help with that goal.

Would you wait until after a tornado struck your home to obtain homeowners insurance and then expect the new company to pay for the damage done before your coverage began? Waiting until you're sick to try to obtain insurance is basically the same thing. The tornado has struck and now you're saying "oh shit I better get covered."

HIPPA regulations currently limit the wait time for a pre-existing condition to be covered to 12 months, but most companies will waive this, again, if you've had insurance previously. This is due to the probability that you've been receiving treatment for it and have not just allowed it to get worse (and exponentially more expensive to address).

Insurance companies are companies; they do not print their own money and they do not have limitless resources. If there are no pre-existing clauses the alternative is to set the premium based on the anticipated expenses, which means that your coverage will cost you. A lot. The funny thing is that people who decide not to get coverage until they're sick expect to pay the same premium as a healthy person, and if you shop around enough you may be able to find a company with a wide enough margin to give that to you, but don't count on it.

Elimination of a pre-existing clause while simultaneously keeping the premium low is like telling somebody you'll pay them $500 a month for the use of their credit card and then charging $20,000 a month to it. You're leaving that person holding the bag for the extra $15,000; is that really fair? Maybe if they have lots of other people paying $500 per month and charging less than that. It's a big maybe.

So what's the answer to this issue? Simple, get coverage while you're healthy.