Coverage for Pre-Existing Conditions
Health insurance companies can’t refuse to cover you or charge you more just because you have a pre-existing condition. They also can’t charge women more than men.
Being sick won’t keep you from getting coverage
Your insurance company can’t turn you down or charge you more because of your pre-existing health or medical condition like asthma, back pain, diabetes, or cancer. Once you have insurance, they can’t refuse to cover treatment for your pre-existing condition.
This is true even if you’ve been turned down or refused coverage due to a pre-existing condition in the past.
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.
When you get care for a pre-existing condition, you’ll still need to pay any deductibles, copayments, and coinsurance your plan requires. It doesn’t matter whether you’re being treated for a pre-existing or new health condition.
Questions? Help is available 24 hours a day, 7 days a week.
One exception: Grandfathered plans
The only exception to the pre-existing coverage rule is for grandfathered individual health insurance plans — the kind you buy yourself, not through an employer. They don’t have to cover pre-existing conditions.
If you have one of these plans you can switch to a Marketplace plan that covers pre-existing conditions.
- You can do this during open enrollment, but be sure to contact your insurance company first to learn about how and when you can cancel your current plan.
- You can also buy a Marketplace plan outside open enrollment when your grandfathered plan year ends. Your plan ending gives you a special enrollment period to enroll in different coverage.
Source: HealthCare.gov, “How does the health care law protect me?” http://www.Healthcare.gov. Accessed December 2, 2015. https://www.healthcare.gov/how-does-the-health-care-law-protect-me/#part=3
© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.
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