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What if I have pre-existing conditions that require ongoing care?
What if I have pre-existing conditions that require ongoing care?

Pre-existing conditions are covered by major medical plans, but what if I'm on an alternative insurance plan?

Support avatar
Written by Support
Updated over a week ago

Keep in mind that major medical plans are required to cover pre-existing conditions. They only come to play with alternative plans, like Christian sharing ministries such as Medi-Share. If you are on an alternative plan that does not cover pre-existing conditions, we're here to help you find the best option for you.


You'll want to run through our online survey to get a specific recommendation for a plan that covers what you need and minimizes your total cost.


We look for ways to try to help you minimize your total cost for the year:

Total Cost = Premiums + Cost of Care

Many people get overwhelmed trying to “shop” for health insurance because it's hard to try to factor in unknowns: “what if I get sick or in an accident?”

At Take Command Health, we've studied this a lot and can apply some data science: Statistically, over 75% of your costs in the next year are predictable based on your known needs. The odds of you having a catastrophic accident or developing a a chronic disease are <1%.

In that case, what really drives costs, and therefore your plan choice, are the things you already know you'll need: prescriptions, doctors visits, therapy, medical equipment, etc. If you have a pre-existing condition or know you'll need care, we'll want to estimate what your cost of care will be on each plan so we can find the plan with the best balance.

To do that, we break your expected care down into "episodes of care" and use medical billing codes (CPT and ICD). The reason is that your care will have a different cost on each plan. For instance a 20 minute doctor visit may cost $150. If you have a plan with a $20 copay, then you'll just pay $20. If you have a high-deductible plan, you may owe the full $150. There are also differences with in-network and out-of-network providers, negotiated rates between the carriers and doctors, etc. to consider.

A critical mistake people make though, especially people that need care, is they forget about the cost of the premium. In the example above, the plan with the $20 copay might be $200 more a month than the high deductible one that charges you the full $150 for the doctor visit. If you see this doctor only once or twice a year, you're better off paying the $150 each time and saving $200 a month.

That's an over-simplified example, but makes a point--don't forget about the premium you're paying!

When you go through our site and tell us you take a regular prescription or have a pre-existing condition, we automatically build an average health profile based on people with similar conditions based on your gender and age range. We use real medical codes and actual health transactions. We're at about 13 million records and growing.

It won't be a perfect estimate of your care, but it's a good start. We then run those care needs through each of the plans in your area, accounting for each plan's unique attributes--deductibles, copays, coinsurance, etc.

From there, it's just simple math to help you balance the equation above. We should note that your specific cost of care is likely to differ from our averages, but in general we've gotten pretty good at helping people with conditions find plans that are best structured to meet their needs.

In summary, if you have conditions, take our survey and let us help you find a plan that's structured to cover your needs most effectively.

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