Massachusetts Health & Accident Insurance Practice Exam

What is the maximum time frame that a preexisting condition can be excluded under a new health insurance plan?

1. 6 months

2. 12 months

3. 18 months

4. 24 months

The correct answer is: 12 months

The maximum time frame that a preexisting condition can be excluded under a new health insurance plan is 12 months. This is in line with the regulations established by the Affordable Care Act (ACA), which prohibits health insurance plans from imposing waiting periods longer than this duration. Prior to the ACA, many plans could enforce longer exclusions as a means to mitigate risk, but the law was designed to enhance consumer protections by limiting these exclusions to one year. In addition, if a person had previous health coverage and did not experience a gap in coverage of more than 63 days, they could potentially shorten this exclusion period. This assured individuals that they would not face penalties for their health history when seeking new insurance, promoting better access to necessary health services. Consequently, options indicating time frames longer than 12 months do not align with current health insurance regulations regarding preexisting conditions.