Coverage for Pre-existing Conditions

What does "pre-existing condition" mean?

A pre-existing condition is any disease, diagnosis or health problem that an individual you already had before applying for health insurance.
 Some common examples include:

  • Diabetes
  • Hypertension
  • Asthma
  • High cholesterol
  • Depression or anxiety
  • Cancer or diseases treated in the past

Prior to 2014, many insurance companies denied coverage or charged higher premiums to those who had these antecedents.
 But thanks to the Affordable Care Act (ACA / Obamacare)it no longer allowed.

The law protects you

Since the entry into force of the Affordable Care Act (ACA)insurance companies cannot deny coverage, increase prices or apply waiting periods for existing medical conditions.
In other words, all persons qualifyregardless of your health history.

This protection is one of the most important pillars of the law, and applies to both adults and children.

Why is this protection important?

Because it guarantees that no one is excluded from the health care system for his medical condition.
 Having a condition such as diabetes, cancer or high blood pressure should not prevent you from having insurance or receive treatment when you need it.

Thanks to this law:

  • You can enroll during the Open Enrollment Period or when you qualify for a Special Enrollment Period (SEP).
  • You will receive full coverage from the start of the plan.
  • Treatments, medications and controls related to your condition will be included.

How coverage works in these cases

When you fill out your application for health insurance through the Marketplace, you do not have to declare or answer medical questions.
 The system evaluates your eligibility only based on your income, age and family compositionnot for your health.
Once enrolled, your policy will cover:

  • Medical consultations and specialists
  • Laboratories and tests
  • Hospitalizations and emergencies
  • Treatments and prescription drugs
  • Preventive services at no additional cost

Your diagnosis does not limit your benefits or affect your monthly price.

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Relationship to your subsidy plan

Pre-existing conditions do not affect the amount of subsidy you receive.
 The amount of government assistance is calculated solely on the basis of your family income and household sizenot on your state of health.

This means that you can receive financial assistance even if you are already under treatment or taking continuous medication.

Cases where this protection does not apply

It is important to know that this coverage only applies to Marketplace plans (ACA).
 Not applicable in:

  • Short-Term Health Plans ("Short-Term Plans")
  • Medical discount programs
  • Temporary or private off-market hedges

Therefore, it is always advisable to consult with a certified consultantlike our team at Ocando Seguros, to make sure you choose a plan that is right for you. that complies with all federal protections.

Practical example

Maria has had type 2 diabetes for 5 years. Thanks to the ACA, she is able to enroll in a medical plan that covers her endocrinologist visits, blood tests and monthly medication - without paying extra fees for her condition.

Our goal is for you and your family to have affordable, reliable and seamless insurance.

How we can help you

At Ocando Insurancewe guide you step by step to:

  • Choose a plan that is compatible with your medical needs.
  • Check if you qualify for subsidies that reduce your monthly payment.
  • Ensure that you receive continuous care without exclusions or delays.

Our mission is that every person has access to quality insuranceregardless of their health condition.

Schedule your free consultation

Do you have a pre-existing medical condition? You are not alone.
 Schedule an appointment with us and discover all the options you have available to you under the Affordable Care Act (Obamacare).

📞 Give us a call or WhatsApp us - we'll be happy to help you find the best coverage for you.

Informative note

The laws and benefits described apply to Health Care Marketplace (ACA) plans. Plan availability and coverage may vary depending on your state and carrier.