What If I Have a Pre-Existing Health Condition?
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 2017 health plan & give birth or adopt after you enrolled:
- If you give birth or adopt before January 31, 2017, you can report the update on your application by logging in to report the change.
- If you give birth or adopt after January 31, your child’s birth or adoption will qualify 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.
- If you have a 2016 health plan & give birth or adopt in the final months of 2016: Having a baby or adopting a child qualifies you for a Special Enrollment Period so you can enroll in or change plans for the rest of 2016. Your coverage can start the day of the event — even if you enroll in the plan 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 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.