Can UnitedHealthcare Deny Coverage for Preexisting Conditions?

UnitedHealthcare cannot deny coverage for preexisting conditions on most of their major medical health insurance plans. However, there are some exceptions where preexisting conditions may not be covered by UnitedHealthcare plans.

What is a Preexisting Condition?

A preexisting condition is a medical condition that someone has before enrolling in a new health insurance plan. Some examples of preexisting conditions include:

• Diabetes
• Cancer
• Asthma
• High blood pressure
• Pregnancy
• Mental health conditions

In the past, insurance companies could deny coverage altogether or charge higher premiums for people with preexisting conditions. This made it very difficult for many people to get affordable health insurance if they had any preexisting conditions.

Preexisting Condition Coverage Under the ACA

The Affordable Care Act (ACA) changed the rules regarding preexisting condition coverage. As of 2014, the ACA prohibits health insurance companies from denying coverage or charging more due to preexisting conditions.

This applies to all major medical plans purchased through the federal and state-based ACA health insurance marketplaces. It also applies to most employer-sponsored group health plans and Medicaid expansion plans.

So under the ACA, UnitedHealthcare cannot deny coverage or charge higher premiums based on preexisting conditions for their ACA marketplace plans or employer-sponsored group plans.

Exceptions Where Preexisting Conditions May Not Be Covered

While UnitedHealthcare cannot deny overall coverage due to preexisting conditions on ACA and employer plans, there are some exceptions where preexisting conditions may not be covered:

Short-Term Health Insurance Plans

UnitedHealthcare offers short-term health insurance plans that are designed to fill temporary gaps in coverage. These plans can deny coverage outright or exclude coverage for preexisting conditions.

Short-term plans do not have to comply with all ACA regulations, including the ban on preexisting condition exclusions. When applying for short-term coverage, you may have to answer health questions and undergo medical underwriting.

If you have certain preexisting conditions, you may be denied coverage altogether for a UnitedHealthcare short-term plan. Or the plan may exclude treatment for your specific preexisting conditions while covering other medical care.

Always read the fine print to understand how preexisting conditions are handled when considering a UnitedHealthcare short-term plan.

Grandfathered ACA Plans

While rare, there are still some “grandfathered” ACA marketplace plans that existed before the ACA was passed in 2010. Grandfathered plans do not have to follow all ACA regulations.

UnitedHealthcare grandfathered ACA plans can impose preexisting condition exclusions or waiting periods. However, this represents only a very small subset of UnitedHealthcare’s ACA offerings at this point.

Medicare Supplement (Medigap) Plans

Medicare supplement or Medigap plans help pay costs like deductibles and coinsurance not covered by Original Medicare. However, Medigap plans do not have to cover preexisting conditions in most states.

If you have a preexisting condition when applying for a UnitedHealthcare Medigap plan, the plan may impose up to a 6-month waiting period before covering that specific condition.

So while a UnitedHealthcare Medigap plan cannot deny you overall coverage due to a preexisting condition, it may temporarily exclude coverage for treatment of that specific preexisting condition for several months.

Summary of Preexisting Condition Coverage with UnitedHealthcare

• For UnitedHealthcare ACA health plans (including employer group plans), preexisting conditions cannot be excluded or denied coverage.

• For UnitedHealthcare short-term plans, preexisting conditions likely will not be covered. You may also be denied overall coverage.

• For UnitedHealthcare grandfathered ACA plans (very rare), preexisting conditions may not be covered or have a waiting period.

• For UnitedHealthcare Medicare Supplement (Medigap) plans, preexisting conditions often have a temporary waiting period (up to 6 months) before coverage.

Always carefully review the plan details before assuming preexisting conditions are covered with any health insurance plan. While the ACA prohibits preexisting condition exclusions on most major medical coverage, there are still some exceptions with certain non-ACA compliant plans.

Frequently Asked Questions

What medical conditions are considered preexisting?

Any medical condition that you have before enrolling in a new health insurance plan is considered preexisting. This includes chronic conditions like diabetes, mental health disorders, cancers, autoimmune diseases, and others. It also includes pregnancy and temporary conditions like a sprained ankle. Even genetic predispositions to certain medical conditions can be considered preexisting.

What if I don’t know I have a preexisting condition?

Insurance companies maintain that if you have a health condition but are unaware of it, it is still considered preexisting once diagnosed. This is why it’s important to undergo health screenings and checkups on a regular basis – to become aware of any medical issues as soon as possible.

Can a health insurance company cancel my coverage if I have a preexisting condition?

Under the ACA, insurance companies cannot rescind or cancel your coverage once you are enrolled in a plan due to a preexisting condition. The only exception is if you intentionally lied or omitted health history information on your application that would have affected your eligibility.

What should I do if dealing with a preexisting condition exclusion?

First, carefully review your plan details to understand the exact exclusion that applies and any time limits. For employer plans, check if your company offers any other plan options without exclusions. For ACA plans, shop on the marketplace during open enrollment for a plan without exclusions. You may also qualify for a special enrollment period.

Are preexisting condition exclusions legal?

Yes, health insurance companies can still impose preexisting condition exclusions and waiting periods on some types of insurance plans. This includes short-term insurance, grandfathered plans, and Medigap. These plans are not required to follow the ACA prohibition against preexisting condition exclusions.

What will happen if the ACA is repealed?

If the ACA is repealed in full at some point, insurance companies would likely go back to denying coverage and charging more for preexisting conditions on individual/family plans. It’s unclear if employer group plans would remain protected or not under a full ACA repeal.

Key Takeaways

• Under the ACA, UnitedHealthcare cannot deny coverage or charge more for preexisting conditions on marketplace and employer group health plans.
• Exceptions include short-term plans, grandfathered plans, and Medigap plans where preexisting conditions may not be covered or have temporary waiting periods.
• Always check plan details closely to understand how preexisting conditions are handled.
• Shop carefully for plans during open enrollment if you have a known preexisting condition.
• Let your legislators know if having robust preexisting condition protections is important to you.