Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can’t charge women more than men.
These rules went into effect for plan years beginning on or after January 1, 2014.
What This Means for You
Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition. Learn more about coverage for pre-existing conditions.
One Exception: Grandfathered Plans
The pre-existing coverage rule does not apply to “grandfathered” individual health insurance policies. A grandfathered individual health insurance policy is a policy that you bought for yourself or your family on or before March 23, 2010 that has not been changed in certain specific ways that reduce benefits or increase costs to consumers.
Pre-Existing Condition Insurance Plan (PCIP) Coverage
The Pre-existing Condition Insurance Plan (PCIP) ended on April 30, 2014. The PCIP program provided health coverage options to individuals who were uninsured for at least six months, had a pre-existing condition, and had been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. Now, thanks to the Affordable Care Act, health insurance plans can no longer deny anyone coverage for their pre-existing condition, and so PCIP enrollees can transition to a new plan outside of the PCIP program. Learn more about your health insurance options at HealthCare.gov.
A Real Story
For James of Pensacola, FL, a normal week involves hunting, welding, fishing, and before January 1st, 2014, worrying about his lack of health insurance. James is a diagnosed diabetic. Thanks to the Affordable Care Act, James was able to enroll in coverage without worrying about his pre-existing condition. Watch his video and read more about his story.
For More Information
- Read the regulation (detailed legislative information).
- Coverage for pre-existing conditions
- Learn more about your rights and protections
- Find help in your area at https://localhelp.healthcare.gov/.