Hypertension, more commonly known as high blood pressure, impacts over 103 million American adults, according to the
Hypertension could be considered a preexisting condition by some insurance companies, because it elevates your risk of heart attacks and stroke, among other medical events. However, due to current laws, their ability to alter or deny your coverage is highly regulated. Keep reading for full details on your rights.
A preexisting condition is a health condition that pre-dates an application you make for a health insurance policy. Prior to 2010, when the Affordable Care Act (ACA) was passed, some preexisting conditions were grounds for an insurance provider to refuse to cover you. The ACA now prohibits insurance providers from charging people with preexisting conditions extra or excluding their condition from their coverage.
Hypertension alone could be considered a preexisting condition by insurance companies, according to the Kaiser Family Foundation (KFF). However, it was not necessarily considered a “declinable” condition that would bar insurance companies from granting you a policy. Prior to the ACA, hypertension could have been a reason for health insurance companies to raise your rates with what was known as a premium surcharge.
Hypertension is tricky because while it can have severe health consequences, it’s also extremely common. Hypertension is linked to heart disease, but it is not the same as having heart disease.
Preexisting conditions are sometimes determined by what treatment is used, and hypertension can also often be treated with lifestyle modifications, such as diet and exercise. However, some people who have hypertension will require medication for the duration of their life.
In short: Yes. Health insurance companies cannot deny you coverage for care because of a preexisting condition.
Preexisting conditions are currently covered by health insurance in the United States. It is not legal for insurance companies to deny you or charge you more based on a health condition that you had before your policy began.
If you were enrolled in your current health insurance plan prior to 2010, you may be enrolled in a plan that is “grandfathered” into the old health insurance laws. These types of plans can still deny coverage or exclude coverage of certain health conditions.
There are also products called “short-term” health insurance. These health insurance policies provide a contract of up to 364 days, and cannot be renewed for more than 3 consecutive years. Short-term health insurance plans are allowed to make exclusions for preexisting conditions, and they are only available in certain states.
Life insurance companies are still allowed to charge you additional premium fees because of hypertension, and some companies may refuse to offer you a policy based on the condition.
Is hypertension considered a preexisting condition for the COVID-19 vaccine?
Hypertension is not considered a preexisting condition for early eligibility for the COVID-19 vaccine. However, you also no longer need a preexisting condition to qualify for the vaccine.
COVID-19 vaccines and booster shots are currently available and recommended by the Centers for Disease Control and Prevention (CDC) to anyone over the age of 5. You can learn more about COVID-19 vaccines and boosters here.
If you need to advocate for yourself with your insurance company, be prepared. The best outcome will happen when you follow these steps:
- During doctor’s appointments, ask if treatments and prescriptions are typically covered and if there are alternative treatments in case your claim is denied. You can try to get pre-approved for certain treatments by obtaining a billing code and calling your insurer directly before you start a new treatment.
- Gather all necessary paperwork including notes from your doctor, other medical professionals, prescriptions, and billing documents before making an initial phone call.
- Set aside an hour where you are undistracted and in a calm, quiet environment to call your insurance company. Make sure this call is made in advance of any deadlines or due dates.
- Write questions down in advance, including possible follow-up questions. If possible, have someone else listen to the call with you to take notes and help you recall information later on.
- Be as pleasant as possible with the insurance representative, take note of their name and position, and do your best not to raise your voice.
- Know what you are entitled to before you make contact with your insurance company so that you won’t compromise or agree to something that shouldn’t be your obligation.
- Be willing to end the call without a resolution and try again.
Insurance companies can no longer decline your coverage because of hypertension, but there are other financial and mental health challenges when you live with hypertension long term.
You may also want to consider lifestyle modifications that can lower your blood pressure if you are able to. Managing your blood pressure can reduce your risk of stroke and heart disease and improve your quality of life.
Steps to consider include:
- eating a low-sodium diet
- limiting your alcohol intake
- walking regularly
- eating healthy and maintaining a healthy weight
- reducing stress
Chronic health conditions like hypertension can be overwhelming, but you’re not alone. You may find it helpful to join a support group for those with high blood pressure. Ask your doctor about groups in your area, or check out these online resources:
- Pulmonary Hypertension Association is an educational platform for those with hypertension and their caregivers, and it offers support groups.
The American Heart Associationregularly holds events to raise awareness and funds for research on all types of heart conditions.
- You can also try the High Blood Pressure Support Group on Facebook to connect with others going through the same thing you are.
Insurance companies cannot deny you care based on any preexisting condition, including hypertension. That doesn’t mean that dealing with your insurance company to cover hypertension-related treatment will be easy.
Get informed about your condition and treatment options that are available to you to get the maximum benefit available from your insurance provider. You can also treat hypertension at home with a few lifestyle adjustments.