Health Insurance for Pre-Existing Conditions « Health Insurance Advisory

Health Insurance for Pre-Existing Conditions

Do you or a family member have pre existing health conditions and not sure if you qualify for an individual medical insurance plan?   Find out now with our exclusive Insurability Profile Tool. It is fast, free and confidential, and provides immediate feedback regarding how health insurers are likely to respond to your health status.

Perhaps you are healthy, but do not want or cannot pay the high cost of individual major medical insurance plan?  There are affordable options for medical insurance.

Health insurance for pre existing conditions, also known as guaranteed health insurance, is designed for people with 1) pre existing medical conditions or 2) want a more affordable alternative to comprehensive major medical insurance.   These plans are considered the most affordable because they generally pay a fixed dollar amount for each covered healthcare expense (versus a percentage, such as 80%).

Guaranteed Health Insurance- typical provides fixed payments for:

  • Physician office visits
  • Diagnostic services, lab and x-ray
  • Radiology
  • Anethesiololgy
  • Inpatient and outpatient surgery
  • Inpatient confinement
  • Preventive care

These medical insurance plans have many names.  They are also referred to as:

  • Mini-Meds
  • Gap Plans or Insurance
  • Scheduled Health Insurance
  • Defined Benefit Plans
  • Limited Benefit Plans
  • Guaranteed Acceptance Plans
  • Guarantee Issue Health Insurance
  • Supplemental Health Insurance
  • Pre-Existing Condition Medical Insurance

“Guarantee issue” means you are assured of obtaining medical insurance because the coverage is not medically underwritten (you are not required to provide your health history when you apply).  Today, health insurers medically underwrite applicants that apply for an individual or family major medical insurance plan. As a result, not everyone will qualify for individual, family of self-employed major medical insurance based on their health status.


  • The new healthcare law, effective September 2010, requires health insurers to cover children less than 19 years of age regardless of their health status.  This new requirement is applicable to group or employer sponsored health insurance and individual or family major medical insurance.
  • Effective January 2014, health insurers carriers will be prohibited from medical underwriting all applicants and restricting coverage in any way due to pre existing conditions.

Guaranteed health insurance plans, like most other forms of medical insurance, will not immediately cover pre existing medical conditions. Most insurance companies define a  pre existing condition as any health condition (whether treated or not) that as a result of an illness or accident existed prior (usually 6 to 12 months) to the effective date of the policy. This means the medical plan will not not cover the health condition(s) until you are consecutively covered for the required time frame, usually12 months.

Considering going without medical insurance?  Probably not a wise decision.  What is one the first questions the receptionist asks you when calling to make an doctors appointment?  “Do you have medical insurance?”  Not having medical insurance will often result in denied or restricted access to healthcare services and leave you with a pile of very expensive bills to pay.

Advantages of a Guaranteed Health Insurance Plan

A Guaranteed Health Insurance Plan may be an alternative if you:

  • Currently have high deducible major medical insurance and want supplemental health insurance to help cover your “underneath” healthcare expenses (medical expenses less than the high deductible).  Note: If you currently have or are contemplating the purchase of an Health Savings Account, most Gap Plans will disqualify the HSA, per IRS regulations.
  • Feel that individual major medical insurance is not needed, but at least want some protection and a medical ID card to get access to the healthcare system in the event you incur unexpected medical expenses.
  • Want to avoid paying retail for healthcare expenses.  Since most Guaranteed Health Insurance Plans include a preferred provider network, the typical discount ranges from 10% to 25%.  Additionally, you generally will not owe your healthcare provider the difference between their retail charge and the negotiated rate.

Since most Guaranteed Health Insurance is considered supplemental health insurance, it is not major medical insurance and therefore not subject to the new health care law.  As a result, these medical insurance plans are not required to meet the minimum coverage requirements.  Benefits are generally paid according to a fixed payment schedule (rather than a percentage, i.e. 80%).  This means the benefit payment is made without regard to how much your healthcare provider bills for the services rendered.

Have you seen or heard the recurring radio and television commercials that advertise “affordable medical insurance regardless of your health status?”  These companies are promoting a guaranteed health insurance plans.  While this type of medical insurance is not major medical insurance, it definitely fills a niche in the individual and self employed medical insurance marketplace, and helps people get medical insurance that otherwise could not.

Get an online health insurance quote today for a guaranteed health insurance plan.  It is fast and easy!

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