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Is Depression a Pre-Existing Condition?

Article | June 2019

Is Depression a Pre-Existing Condition?

Depression is not a simple case of the “blues.” In fact, depression can be a very serious illness that left untreated can have long-term effects on your health, both emotionally and physically. When you’re considering choices in health plans, it’s important to know if depression is covered as a pre-existing condition and under what terms.

When is depression a pre-existing condition?

In health insurance terms, depression is a pre-existing condition if you have seen a provider for it or been diagnosed with it during a specified period of time before you sign up for a new health plan. Like other pre-existing conditions, depression is often a long-term condition that may require on-going care and treatment. This long-term care may extend over the life of many health plans. Before the Affordable Care Act (ACA) was enacted, health insurers could refuse you coverage for pre-existing conditions, including depression. Or, they could offer you coverage at much higher rates.

Can you be denied coverage for depression that’s pre-existing?

The Affordable Care Act (ACA) made it illegal for insurance companies to refuse you coverage for a pre-existing condition like depression, along with many other kinds of pre-existing conditions. This law applies to health plans that continue to follow ACA guidelines. ACA plans cannot charge you more or raise your rates just because you have been diagnosed or have received or are currently receiving, treatment for depression.

As the political landscape shifts, there could be new health plans made available that do not follow ACA standards. They may not offer coverage for pre-existing conditions such as depression. Make sure you understand all the details of any health plan before enrolling, especially how pre-existing conditions are covered.

What is the best insurance for pre-existing depression?

Depression may be covered under many different types of health plans, as part of mental health and substance use coverage, sometimes called behavioral health coverage. This type of coverage is included in many medical plans:

  • If you are buying insurance on your own and not through an employer, shop for individual health plans through the Health Insurance Marketplace at HealthCare.gov. These health plans are typically ACA-compliant, which means they cover eligible treatment for pre-existing depression. You will want to choose a health plan that covers treatment for mental health and substance use, or behavioral health.
  • If you get your health plan through your employer, you will likely have a few plans to choose from. To find out if depression is covered as a pre-existing condition, read the details of each plan. Make sure the plan you choose includes coverage for mental health and substance use, or behavioral health.

Always ask questions if you are unsure whether pre-existing conditions are covered.

Do all health plans have to cover depression as a pre-existing condition?

All ACA-compliant health plans you buy on your own through the Health Insurance Marketplace will cover pre-existing conditions. You will need to purchase a plan that offers coverage for mental health and substance use, or behavioral health to have coverage for depression that’s pre-existing.

Health plans you get through your employer that come from major health insurance carriers will also typically consider depression a pre-existing condition. Exceptions would be plans that do not provide comprehensive medical coverage, such as some short-term, catastrophic health plans, or supplemental health plans like vision or disability.

Grandfathered health plans, or those enrolled in prior to 2010, are not required to cover pre-existing depression. These are much less common.

As the health insurance industry changes, there could be certain types of health plans entering the market that do not cover pre-existing conditions. It’s important to shop for health plans carefully and know ahead of time if depression is covered as a pre-existing condition.

This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. Any third party content is the responsibility of such third party. Cigna does not endorse or guarantee the accuracy of any third party content and is not responsible for such content. Your access to and use of this content is at your sole risk.

Sources:
Mental health & substance abuse coverage, HealthCare.gov, https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/, accessed May 23, 2019.