Does health insurance cover a pre-existing condition?
The Affordable Care Act – also known as the ACA or Obamacare – provides health care coverage protections to people with preexisting conditions.
Learn how this law affects you below.
What is a preexisting condition?
A preexisting condition is a health condition you had before your health care coverage started.
What qualifies as a preexisting condition?
Preexisting conditions tend to be chronic, long-term illnesses. Conditions like asthma, COPD, sleep apnea, diabetes and cancer could all be preexisting conditions.
What does the Affordable Care Act (ACA) say about it?
Before the ACA, health insurance providers could deny people coverage or charge significantly more for a long-term illness. Now, all Marketplace plans through the ACA are required to cover treatment for preexisting medical conditions.
Under the ACA, health insurance companies also can’t charge women more than men for the same coverage.
Can insurance be denied for preexisting conditions?
Insurance plans can’t deny you coverage for a condition you had before your coverage.
Pregnancy care and childbirth are also covered starting on the day your plan begins. If you’re pregnant and applying for coverage, an insurance company can’t reject you or charge you more based on your pregnancy.
Can insurers charge more for preexisting conditions?
Insurers can’t charge you more or refuse to pay for essential health benefits for any preexisting condition. And after you’ve enrolled, your health insurance company can’t raise your rates based only on your health.
What are some exceptions to preexisting conditions coverage?
Grandfathered individual health insurance plans are the only exception to the ACA’s preexisting coverage rule. Plans purchased on or before March 30, 2010, aren’t required to cover preexisting conditions or preventive care.
If you have a grandfathered plan and want coverage for preexisting conditions, you have two options:
- You can switch to a Marketplace plan during open enrollment.
- You can buy a Marketplace plan outside of open enrollment when your grandfathered plan ends. This qualifies you for a special enrollment period.
Current Sanford Health Plan members can access their summary of benefits and coverage through our secure member portal or by contacting customer service using the number listed on the back of their member ID card.
If you’re ready to compare plans for yourself, find our buyer’s checklist here. You can also call us at (888) 501-4560 to talk to one of our experts and start setting up your plan. Related Content How to find health insurance after losing coverage The benefits of working with an agent