Getting Medical Coverage in Wisconsin with a Pre-Existing Condition

  • September 13, 2016
  • |Quartz
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As a result of the Affordable Care Act (ACA), you may now get medical coverage in Wisconsin even if you have a pre-existing condition. The law also states that health insurance companies can’t charge you more because of a pre-existing condition.1

This is very good news for people who may have long-term health problems such as asthma, hypertension, diabetes or cancer. Even if you’ve been denied coverage in the past, insurance companies must provide you with medical insurance coverage. Those with pre-existing conditions will generally not face special insurance coverage conditions. Therefore, like everyone else with health insurance, they may also be expected to pay deductibles, copayments and coinsurance costs, and they may need to use network doctors and facilities or pay the full price for out-of-network treatment.

If you already have medical coverage and develop a serious health problem, WI insurance companies may not cancel or deny you from covered medical treatment outlined in your plan.

An exception to the ACA’s pre-existing condition health coverage rule

Some people may have grandfathered individual health insurance plans, which do not have to provide medical coverage for pre-existing conditions.2These grandfathered plans are those that were in existence on March 23, 2010 and haven’t been changed substantially since. So if you’ve been on the same plan since 2010, it’s a good idea to find out if your plan has grandfather status.

If you do have a grandfathered individual plan, the plan may continue to have yearly limits on coverage, so it’s very important to know (if you have a grandfathered plan, your insurance company should have notified you). If you are concerned about your insurance coverage, check your health plan materials, or call your insurance company today.


Review the materials to see if the plan has annual limits on coverage. If so, you may want to shop for a different plan during the next open enrollment period that includes the coverage you need.

Ready to look for a new plan? Choose Unity Health for medical coverage that includes access to Wisconsin's #1-rated hospital – UW Health Hospital and Clinics*–  as well as a wide range of doctors and specialists in central Wisconsin. Shop our wide variety of health plans and get a quote today.


*According to 2015-2016 edition of the Best Hospitals guide by U.S. News & World Report.


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