ACA Coverage for pre-existing conditions

All Marketplace plans must cover treatment for pre-existing medical conditions.

• No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
• Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
• Medicaid and the Children's Health Insurance Program (CHIP) also can't refuse to cover you or charge you more because of your pre-existing condition.

Pregnancy is covered from the day your plan starts

• If you’re pregnant when you apply, an insurance plan can’t reject you or charge you more because of your pregnancy.
• Once you’re enrolled, your pregnancy and childbirth are covered from the day your plan starts.
  • If you have a 2018 health plan & give birth or adopt after you enrolled:
    • Your child’s birth or adoption qualifies you for a Special Enrollment Period. This means you can enroll in or change plans outside the annual Open Enrollment Period.
    • Your coverage can start from the date of birth or adoption, even if you enroll up to 60 days afterward.

Learn more about coverage for pregnancy and childbirth.

Exception: grandfathered plans don’t have to cover pre-existing conditions

Grandfathered plans don’t have to cover pre-existing conditions or preventive care. If you have a grandfathered plan and want pre-existing conditions covered, you have 2 options:

• You can switch to a Marketplace plan that will cover them during Open Enrollment.
• You can buy a Marketplace plan outside Open Enrollment when your grandfathered plan year ends, and you’ll qualify for a Special Enrollment Period.

Learn more about grandfathered plans and what to do when your plan is changed or cancelled.