Transparency First
PRE-X: Pre-Existing Conditions & How MightyWELL Handles Them
We believe you deserve clarity — not fine print. Here's exactly how pre-existing conditions work, why the model is structured this way, and how it protects every member in the community.
No Fine Print. No Surprises.
Most people have heard horror stories about health coverage and pre-existing conditions — denied claims, buried exclusions, or premiums that spike the moment you actually need care. MightyWELL takes a different approach: a structured, gradual phase-in that's spelled out clearly before you ever enroll.
Health sharing works because members look out for each other. The phase-in model protects that community — it keeps the pool sustainable so that when you need support, it's actually there. We'd rather be upfront about how it works than have you find out at the worst possible moment.
Day-One Access to Everyday Care
While the phase-in applies to larger medical events tied to pre-existing conditions, your day-to-day coverage starts immediately.
Copay Plans
Fixed-cost doctor visits, urgent care, and specialist appointments from day one — no deductible barrier.
Rx Tiers
Prescription coverage through tiered drug plans — generics, preferred brands, and specialty medications available right away.
Virtual Care & Advocacy
24/7 telehealth, care navigation, and advocacy services to help you get the care you need — without the runaround.
Which Path Is Right for You?
Every situation is different. Here are three real-world scenarios to help you see which MightyWELL plan — or decision — makes the most sense.
Christopher, 43
The HSA Bundle Is His Best Fit
Christopher had a hernia repair 18 months ago. He's healthy, active, and rarely visits the doctor — he just wants protection for the unexpected.
Why this path?
His hernia repair falls within the lookback window, so it enters the phase-in. But since he's recovered and rarely needs large medical events, the HSA Bundle gives him affordable protection while his sharing limits grow each year. He saves significantly vs. traditional insurance.
- Lower monthly cost with high-UA protection
- Phase-in grows his sharing limits over 5 years
- Virtual care & advocacy from day one
Sam & Luna, 34 & 36
The Copay Bundle Fits Their Family
Luna takes thyroid medication and their toddler has frequent ear infections. They need predictable, everyday access — not just catastrophic coverage.
Why this path?
The Copay Bundle gives them fixed-cost doctor visits, urgent care, and Rx tiers from day one — regardless of Luna's thyroid history. The phase-in only affects large claims tied to that condition, which they don't anticipate needing.
- Day-one copays for doctor visits & urgent care
- Rx tiers cover thyroid medication immediately
- Pediatric visits with predictable costs
Andrea, 56
Staying Put Is the Smart Move — For Now
Andrea was recently diagnosed with breast cancer and is starting a treatment protocol. She's drawn to MightyWELL's mission but is unsure about switching mid-treatment.
Why this path?
With an active cancer diagnosis and treatment underway, Andrea's current plan is the right choice right now. Once treatment concludes and her condition stabilizes, she can transition to MightyWELL with confidence — and her phase-in clock starts then.
- Complete active treatment first
- Transition once condition has clarity
- MightyWELL will be here when she's ready
Not sure where you fall? — they'll walk through your situation with zero pressure.
The Lookback Period
When you join, MightyWELL reviews your medical history from the prior 24 months (2 years). Any condition that was diagnosed, treated, or medicated during that window is considered "pre-existing." This is standard across health share programs and keeps the community sustainable.
24-Month Standard Window
We look back 2 years at diagnoses, treatments, and prescriptions to identify existing conditions.
36-Month Cancer Lookback
For cancer specifically, the lookback extends to 36 months. Any testing, preventive treatments, or medications for a previously diagnosed cancer within this window means any recurrence is considered pre-existing.
Community Protection
This structure prevents the pool from being overwhelmed by day-one large claims — keeping costs fair for everyone.
Coverage Grows With You
Members must complete a one-year waiting period before any pre-existing conditions become eligible for sharing. After that, sharing limits increase each year of continuous membership until the cap is fully removed.
Year 1
$0
Waiting period
Pre-existing conditions are not yet eligible for sharing
Year 2
$30K
Sharing begins
Up to $30,000 maximum per need as sharing eligibility begins
Year 3
$60K
Coverage grows
Maximum grows to $60,000 per need with continued membership
Year 4
$150K
Maturing coverage
Up to $150,000 maximum per need as coverage matures
Year 5+
No Cap
Full eligibility
Sharing maximum is completely removed — full eligibility
Exceptions to the Phase-In
Certain maintainable conditions are exempt from this phase-in structure, provided the member has not been hospitalized for the specific condition within the 12 months immediately preceding enrollment:
By year five, a pre-existing condition is treated exactly the same as any new condition. Full eligibility. No asterisks.
When Staying With Your Current Plan Makes Sense
This isn't a one-size-fits-all approach — and we'll tell you honestly if now isn't the right time to switch. Consider staying with your current coverage if:
Have a Pre-Existing Condition?
Let's walk through your specific situation — no pressure, no commitment.